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Treatment – Ambulatory
IV. Ambulatory Management of Alcohol Withdrawal
A. Monitoring
Î Recommendation IV.1: In ambulatory settings, arrange for patients
to check in with a qualified health provider (e.g., medical assistant,
nurse) daily for up to five days following cessation of (or reduction
in) alcohol use. For some patients who are unable to attend daily in-
person check-ins, alternating in-person visits with remote check-ins
via phone or video call is an appropriate alternative.
Î Recommendation IV.2: Re-assessments should focus on the patient's
health since the last checkup. Clinicians should assess general
physical condition, vital signs, hydration, orientation, sleep and
emotional status including suicidal thoughts at each visit. Ask about
alcohol and other substance use and, if available, measure Blood
Alcohol Content (BAC) with a breathalyzer to detect recent alcohol
use.
Î Recommendation IV.3: Alcohol withdrawal severity should be
monitored with a validated instrument (see Alcohol Withdrawal Scales
Table for a summary of scale and their associated features). Patients
who are able to monitor their own signs and symptoms may use an
instrument designed for self-administration such as the Short Alcohol
Withdrawal Scale (SAWS).
Î Recommendation IV.4: In ambulatory settings, patients with a current
or past benzodiazepine use disorder need additional monitoring.
Î Recommendation IV.5: For patients managed in an ambulatory
setting, the following indications would necessitate transfer to a more
intensive level of care such as Level 2-WM (if in a Level 1-WM setting)
or an inpatient setting:
• Agitation or severe tremor has not resolved despite having received multiple doses
of medication, and the patient will not be continually monitored (e.g., treatment
setting is closing )
• More severe signs or symptoms develop such as persistent vomiting, marked
agitation, hallucinations, confusion, or seizure
• Existing medical or psychiatric conditions worsen
• Patient appears over-sedated
• Patient returns to alcohol use
• Syncope, unstable vital signs (low/high blood pressure, low/high heart rate)
