Adicciones y

uso de
sustancias
The Maudsley
Alcohol
Evaluación e intervención estructurada
Evaluación e intervención estructurada
ABSTINENCIA
ABSTINENCIA
DESINTOXICACIÓN
DESINTOXICACIÓN
DESINTOXICACIÓN
DESINTOXICACIÓN
Fixed dose reduction
regimen
Fixed dose reduction
regimen
Sympton triggered regimen
ENCEFALOPATÍA
WERNICKE
ü It is generally advised that patients undergoing inpatient detoxification should be given parenteral
thiamine as prophylaxis.

ü Standard advice is one pair of Pabrinex IM high potency daily (containing thiamine 250mg/dose) for
5 days, followed by oral thiamine and/or vitamin B compound for as long as needed (where diet is
inadequate or alcohol consumption is resumed). All inpatients should receive this regime as an
absolute minimum.

ü If Wernicke’s encephalopathy is suspected, the patient should be transferred to a medical unit

where IV thiamine can be administered.
Prevención de recaidas
Prevención de recaidas
Prevención de recaidas
Prevención de recaidas
Prevención de recaidas
Prevención de recaidas
Prevención de recaidas
Prevención de recaidas
COMORBILIDAD
COMORBILIDAD
COMORBILIDAD
 i u m
l i r s
De men
t r e
v Delirium tremens occurs in around 3–5% of those admitted to hospital for
alcohol withdrawal.

v It is an agitated delirium that develops around 72 hours after the last drink.

v Previous seizures or delirium, low potassium, low magnesium, thiamine

deficiency and systemic disease predispose to its development, as does under-
treated alcohol withdrawal.

you need to see the patient.

v Appropriate management requires joint work between psychiatric, medical and

nursing teams, to identify and correct contributing physical factors such as
electrolyte imbalance, thiamine deficiency and sepsis, while minimising
behavioural disturbance via psychosocial measures (side room for a low stimulus
environment, 1:1 nursing observations, frequent reorientation and reassurance)
and pharmacological treatment. ITU outreach or on call should be informed early,
and should be directly involved if the patient is not accepting oral medication and
requires parenteral high- dose benzodiazepines.
ü All patients with delirium tremens should have IV thiamine (as Pabrinex in the UK) at
treatment dose, as malnutrition is a known predisposing cause of DTs.

ü NICE suggests that haloperidol can be used to manage behavioural distur- bance in
delirium tremens, but others urge caution in view of its cardiotoxicity and propensity
to provoke seizures.

ü Both NICE and the New South Wales guidance suggest olanzapine as a possibility for
behavioural disturbance refractory to benzodiazepines.

ü Loading of benzodiazepines should not be done in patients with chronic obstructive

pulmonary disease (COPD) or other respiratory compromise and it is more likely that
these patients will require respiratory support in order to tolerate medically assisted
detoxification.

ü Care should be taken to monitor respiratory rate (RR) and oxygenation particularly in
those patients who are smokers and may have occult respiratory disease. Prescription
of ‘when necessary’ flumazenil to reverse benzodiazepine toxicity is advisable.