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Î Recommendation VII.4: For patients treated in primary care settings,
regular follow-up visits, at least monthly for one year, could increase
the likelihood of sustained recovery.
B. Emergency Departments
Î Recommendation VII.5: If patients are experiencing severe alcohol
withdrawal (e.g., CIWA-Ar ≥19), or are at risk of complicated
withdrawal, administer medication immediately to treat withdrawal
and reduce the risk of seizures and delirium.
Î Recommendation VII.6: Patients presenting with alcohol withdrawal
syndrome in the Emergency Department should be evaluated for
delirium as well as other conditions that mimic and/or accompany
withdrawal. Patients presenting with delirium should be assessed for
all potential etiologies including alcohol withdrawal.
Î Recommendation VII.7: Patients in the Emergency Department
should receive a complete blood count and complete metabolic panel
including liver enzyme and magnesium tests. Alcohol withdrawal
treatment should not be delayed while waiting for results.
Î Recommendation VII.8: The following indicators should be present for
discharge to an ambulatory alcohol withdrawal management setting
from the Emergency Department:
• Mild alcohol withdrawal (e.g., CIWA-Ar score <10).
• Moderate alcohol withdrawal (e.g., CIWA-Ar score 10–18) with no other
complicating factors
• Not currently intoxicated (including alcohol or other drugs)
• No history of complicated alcohol withdrawal (seizures, delirium)
• No significant medical or psychiatric comorbidities that would complicate
withdrawal management
• Able to comply with ambulatory visits and therapy
Î Recommendation VII.9: Patients with controlled withdrawal syndrome
being discharged from the Emergency Department may be offered
a short term (e.g., 1–2 day) prescription for appropriate alcohol
withdrawal medication to last until follow-up with their healthcare
provider.
