ASAM Pocket Guidelines and Patient Guide

Alcohol Withdrawal Management

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28 Treatment B. Alcohol Withdrawal Delirium (1) Monitoring Î Recommendation VI.7: Patients with alcohol withdrawal delirium should receive close nursing observation and supportive care, which often necessitates admission to an intensive or critical care unit. Agitated and disoriented patients should have continuous, one-to-one observation and monitoring. Î Recommendation VI.8: Patients with alcohol withdrawal delirium should have their vital signs, oximetry and cardiac status monitored as frequently as required. Resuscitative equipment should be readily available when patients require high doses of benzodiazepines, when continuous infusion of medication is used, or when patients have significant concurrent medical conditions. Î Recommendation VI.9: To monitor signs and symptoms of alcohol withdrawal delirium, use a structured assessment scale such as the Confusion Assessment Method for ICU Patients (CAM-ICU), Delirium Detection Score (DDS), Richmond Agitation-Sedation Scale (RASS), or Minnesota Detoxification Scale (MINDS). It is not recommended to use the CIWA-Ar in patients with delirium because it relies on patient- reported symptoms. (2) Supportive care Î Recommendation VI.10: Provide immediate intravenous access for administration of drugs and fluids to patients experiencing alcohol withdrawal delirium. Î Recommendation VI.11: If available and applicable, existing institutional/hospital-associated delirium protocols can be used for supportive care of patients with alcohol withdrawal delirium. Î Recommendation VI.12: Restraints should be used only when required to prevent injuries due to agitation or violence, and in compliance with state laws. (3) Pharmacotherapy Î Recommendation VI.13: Patients with alcohol withdrawal delirium should be sedated to achieve and maintain a light somnolence. Benzodiazepines are recommended as the first-line agents for managing alcohol withdrawal delirium. Î Recommendation VI.14: When available, medication should be administered intravenously. The use of intermittent IV administration of long- and short-acting medications is acceptable and effective. Continuous IV infusion is considerably more expensive and there is no evidence of therapeutic superiority.

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