8
Î Recommendation II.16: In settings with access to laboratory tests,
clinicians should conduct and/or arrange for a comprehensive
metabolic profile (CMP) or basic metabolic profile (BMP), a hepatic
panel, and a complete blood count with differential to assess a
patient's electrolytes, liver functioning, renal functioning, and immune
functioning. In a setting with limited access to laboratory testing,
clinicians should obtain results when practical to assist with treatment
planning decisions. Address any nutritional deficiencies detected.
Î Initial screening may also include laboratory tests for:
• Hepatitis
• Human immunodeficiency virus (HIV) (with consent)
• Tuberculosis
Î Recommendation II.17: Assess patients for polysubstance use and be
prepared to treat other potential withdrawal syndromes. To assess a
patient's other substance use, it may be helpful to:
• Use a validated scale that addresses other substance use, such as the Alcohol,
Smoking and Substance Involvement Screening Test (ASSIST)
• Conduct a urine or other toxicolog y test to detect other substance use
• Utilize information from collateral sources when possible (i.e., family and friends)
Î Recommendation II.18: Do not delay the initiation of treatment if
alcohol withdrawal is suspected but laboratory test results are not
available at the treatment setting or the results are pending.
Î Recommendation II.19: Assess patients for concurrent mental
health conditions, including a review of their mental health history,
to determine their mental health treatment needs. Consult with any
mental health professionals caring for such patients. Obtain written
or verbal consent before consultation whenever possible in non-
emergent situations. The Patient Health Questionnaire (PHQ-9) and
the Generalized Anxiety Disorder (GAD-7) scales can be helpful to
screen for mental health disorders. Be cautious when diagnosing a
new primary mental health disorder during acute withdrawal, since it
can be difficult to differentiate between substance-induced signs and
symptoms and primary psychiatric disorders.
Î Recommendation II.20: Evaluate active suicide risk as part of the
initial patient assessment.
Diagnosis
