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Managing Alcohol Withdrawal
Managing Alcohol Withdrawal
Managing Alcohol Withdrawal
ALCOHOL WITHDRAWAL
Prepared by J. Mabbutt & C. Maynard
NaMO
September 2008
7: Managing withdrawal
Objectives
1.
During the session nurses & midwives will learn how to identify,
assess & manage a patient in alcohol withdrawal
2.
3.
At the end the session, nurses & midwives will have a basic
understanding & knowledge to safely & effectively identify, monitor
& manage alcohol withdrawal
7: Managing withdrawal
The most important thing is to anticipate when it may occur & to suspect
it when an unexplained acute organic brain syndrome is detected
If not treated early it can lead to permanent brain damage & memory loss
young alcohol-dependent people are at risk
Onset of alcohol withdrawal is usually 6-24 hours after the last drink
Usually withdrawal is brief & resolves after 2-3 days without treatment;
occasionally, withdrawal may continue for up to 10 days
Withdrawal can occur when the blood alcohol level is decreasing, even
if the patient is still intoxicated
Autonomic overactivity
Gastrointestinal
Sweating
Anorexia
Anxiety
Tachycardia
Nausea
Vivid dreams
Hypertension
Vomiting
Illusions
Insomnia
Dyspepsia
Hallucinations
Tremor
Delirium
Fever
Table 9.4: Main signs & symptoms of alcohol withdrawal
They occur early (usually 7-24 hours after the last drink), are grand mal
in type (i.e. generalised, not focal) & usually (though not always) occur
as a single episode
Gross tremor
The most systematic & useful way to measure the severity of withdrawal
is to use a withdrawal scale
Research shows that the use of scales minimises both under-dosing &
overdosing with benzodiazepines for alcohol withdrawal syndromes
There has been considerable debate about the application of withdrawal scales
Two different scales, the Alcohol Withdrawal Scale (AWS) and the Clinical
Institute Withdrawal Assessment for Alcohol (revised) (CIWA-Ar) are both are
recommended for use (see Appendices 2 and 3)
Being familiar with the alcohol withdrawal scale used in your local area is a
priority
Note that withdrawal scales do not diagnose withdrawal, but are merely
guides to the severity of an already diagnosed withdrawal syndrome
Several studies have shown that the CIWA-Ar scale is a valid, reliable &
sensitive instrument for assessing the clinical course of simple alcohol
withdrawal
Video options show either of the following from the CIWA-Ar CD ROM
E8 A Case study
Tremor
Paroxysmal sweats
Anxiety
Agitation
Tactile disturbances
Auditory disturbances
Visual disturbances
Monitor the patient hourly for at least 4 hours using the CIWA-Ar
Contact the medical officer or drug & alcohol nurse practitioner for assessment
and monitor hourly if:
the alcohol score increases by at least 5 points over this 4-hour period, or
the CIWA-Ar total score reaches 10
Monitor the patient 4-hourly, using the CIWA-AR, for at least 3 days
If the total score reaches 10, monitor hourly & notify the medical officer
or drug & alcohol nurse practitioner
The AWS (see Appendix 3) is a widely used scale in NSW and is a 7 item
scale that allows a quantitative rating (from 0 to 4) of the following components:
Perspiration
Tremor
Anxiety
Agitation
Axilla temperature
Hallucinations
Orientation
Monitor the patient hourly for at least 4 hours using the AWS
Contact the medical officer or drug & alcohol nurse practitioner for assessment
& monitor hourly if:
the alcohol score increases by at least 5 points over this 4-hour period, or
the AWS total score reaches 5
Monitor the patient 4-hourly, using the AWS, for at least 3 days
If the total score reaches 5, monitor hourly & notify the medical officer
or drug & alcohol nurse practitioner
Depending on the resources of the local area, these may need review
Symptom-triggered sedation
Or until pt is sedated
Medial review required if dose exceeds 80mg & more diazepam can
be ordered depending on withdrawal condition
If sedation necessary; 5-10mg oral diazepam every 6-8 hours for first 48 hrs