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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.
