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Northumberland, Tyne and Wear ftfryEf

NHS Foundation Trust

INTERIM PROTOCOL FOR THE MANAGEMENT OF ACUTE ALCOHOL WITHDRAWAL

This interim protocol is intended for use in areas where there is no current protocol for the management of alcohol withdrawal and will be reviewed when NICE publishes it's guidance on
alcohol use disorders in adults and young people, expected May 2010.

Goals: To minimise morbidity and mortality and maximise patient comfort

through:

o . o . . .

rcogfrition of all alcohol misuser hospital attendees.

identification

of sub-groups with, or at risk of, potentially

life-threatening

complications. prompt initiation of appropriate medical management.

Backqround: Alcohol misuse is a problem throughout the NHS. For example:

around 20o/o of patients admitted for illnesses unrelated to alcohol are drinking at potentially hazardous levels. 12o/o of A&E attendances have been shown to be directly related to alcohol. 34-360/o of orthopaedic admissions and 33-50% of head injury patients have been found to be hazardous or harmful drinkers.

A.lcohol misuse is often unrecognised, the 'skid row' presentation being an uncommon example. Other misusers may be less obvious and may:

. r .

be, or appear to be, sober and in every way unexceptional. have few, if any, signs of alcohol misuse or only non-specific symptoms. have symptoms overlooked during an intercurrent illness.

Tools such as the AUDIT assesment form for alcohol misuse can therefore be a useful aid to identify potential alcohol misuse and this should be used where there may be concerns over alcohol consumption.

Morbidity and mortality: Two life-threatening withdrawal-related complications

make detection of the 'less obvious' misuser vital.

1. Delirium tremens

(DTs) occurs in about 5% of patients during withdrawal, usually 2 to 5 days after alcohol cessation or decreased intake. DTs is fatal in 15-20% of inappropriately managed patients, whilst appropriate prophylactic sedation reduces mortality to 1-5% (see management algorithm). (WE) has been shown to occur in 12.5o/o of alcohol misusers. lt may develop rapidly or over a number of days. lnappropriately managed it is the primary or a contributory cause of death in 17% of patients and results in permanent brain damage in 85% of survivors. WE is initially reversible with parenteral B-vitamins so treatment should be initiated immediately a diagnosis is suspected or risk factors identified (see management algorithm).

2. Wernicke's encephalopathy

Title: Management of Acute Alcohol Withdrawal Protocol Author: Amanda Theaker Date: January 2010

Review Date: July 2010