Complications Of Alcohol Withdrawal Research Articles

1018: SAFETY ANALYSIS OF BENZODIAZEPINE USAGE IN HIGH-RISK PATIENTS WITH SEVERE ALCOHOL WITHDRAWAL

Introduction: Delirium tremens (DTs) and alcohol withdrawal (AW) seizures are severe complications of AW with significant morbidity and mortality. In those with a history of withdrawal seizures or DTs, the administration of a GABAergic agent via a symptom-triggered regimen (STR) or scheduled regimen (SR) is crucial to preventing recurrence of these events. However, some data has shown dosing frequency does not influence these AW complications. The purpose of this study was to assess the safety of STR vs SR benzodiazepine administration in relation to recurrent AW seizures or DTs in patients with severe AW in the intensive care unit (ICU). Methods: Patients were included if admitted to an ICU at our institution between January 1, 2019 and December 31, 2020 with severe AW and a history of AW seizures and/or DTs. Groups were defined based on benzodiazepine dosing schedule: STR vs SR. The primary outcome was rates of recurrent DTs or AW seizures during ICU admission. Secondary outcome(s) include total benzodiazepine exposure. Results: Of 66 encounters identified, 13 patients met inclusion criteria. Six received STR dosing and 7 received SR dosing. Baseline characteristics were similar between groups for age, sex, and race. The STR group had fewer patients with a history of DTs (66% vs 85%) and withdrawal seizures (66% vs 71%) compared to the SR group. No differences were found between groups in incidence of recurrent DTs (16.7% vs 14.3%, p=0.906) and withdrawal seizures (16.7% vs 28.6%, p=0.612). Patients in the STR group received similar median benzodiazepine doses on day 1 (4.5 mg [1 – 11.3] vs 5 mg [3 - 9]) and lower median overall benzodiazepine usage (20.8 mg [7.6 – 41.4] vs 73.5 mg [42.6 – 138]) compared to the SR group. Conclusions: No difference was found in the rate of recurrent DTs or withdrawal seizures between the two dosing groups. However, our study is limited by small sample size and retrospective design. Overall, this study showed that both symptom-triggered and scheduled benzodiazepine dosing may be both safe and effective for patients with AW and a history of DTs or withdrawal seizures.

Impact of alcohol withdrawal training program on knowledge, attitude, and perception among healthcare providers in a hospital setting

ABSTRACT Background Delirium tremens is a life-threatening complication of alcohol withdrawal, which is preventable by prompt recognition and management. This study aimed to evaluate the impact of an alcohol withdrawal training program on knowledge, attitude, and perception among healthcare providers in a hospital setting. Methods This was a quasi-experimental study with a pre and post-test design conducted at the Department of Psychological Medicine, University Malaya Medical Center, Malaysia. A total of 36 participants consisted of postgraduate psychiatry trainees who underwent a 60-min online training program whereby pre- and post-training evaluation was done using a locally validated 21-item knowledge, attitude, perception questionnaire on alcohol withdrawal and the Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) scales. Results There was a significant difference between pre- and post-training scores in knowledge, attitude, and perception domains (p < .05). Furthermore, significant difference in pre- and post-training CIWA-Ar scores (p < .05) were detected. Post-training CIWA-Ar score approached the true value and with minimal variation of scores among the participants. Conclusion The alcohol withdrawal training program was clinically significant with an effect size of 0.75. It can be utilized to train healthcare providers from various departments treating alcohol withdrawal patients to ensure better standardization of care.

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal

Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review.

Stress (Takotsubo) cardiomyopathy is a form of reversible left ventricular dysfunction with a heightened risk of ventricular arrhythmia thought to be caused by high circulating catecholamines. We report a case of stress cardiomyopathy that developed during severe alcohol withdrawal successfully treated with dexmedetomidine. The case involves a 53-year-old man with a significant history of alcohol abuse who presented to a teaching hospital with new-onset seizures. His symptoms of acute alcohol withdrawal were initially treated with benzodiazepines, but the patient later developed hypotension, and stress cardiomyopathy was suspected based on ECG and echocardiographic findings. Adjunctive treatment with the alpha-2-adrenergic agonist, dexmedetomidine, was initiated to curtail excessive sympathetic outflow of the withdrawal syndrome, thereby targeting the presumed pathophysiology of the cardiomyopathy. Significant clinical improvement was observed within one day of initiation of dexmedetomidine. These findings are consistent with other reports suggesting that sympathetic dysregulation during alcohol withdrawal produces ideal pathobiology for stress cardiomyopathy and leads to ventricular arrhythmogenicity. Stress cardiomyopathy should be recognized as a complication of alcohol withdrawal that significantly increases cardiac-related mortality. By helping to correct autonomic dysregulation of the withdrawal syndrome, dexmedetomidine may be useful in the treatment of stress-induced cardiomyopathy.

Delirium tremens : étude rétrospective de 39 observations

IntroductionAlcohol withdrawal delirium (AWD) is one of the most serious complications of alcohol withdrawal. The daily practice of linking activity in addiction shows that this condition is not uncommon. Patients and methodsWe extracted from the hospital database patients’ admissions for which a diagnosis of AWD (F104) was registered between 2004 and 2009. The review of discharge reports allowed to select the patients for which the medical records were analyzed. ResultsThirty-nine patients admitted for DT were selected. Mean age was 48 years (male 89.7%). A majority of patients (89.7%) were admitted through the emergency department. In about a half of cases (51.3%), blood alcohol concentration was null at admission. The main reasons for the admission were alcohol withdrawal syndrome (17.9%), fall/malaise (15.4%), and generalized seizures (12.8%). Approximately one-third of the patients had a medical history of seizures and 23.1% of AWD. No patient had severe liver failure. Six patients (15.4%) were transferred to intensive care. Two patients developed AWD after surgery. No deaths have been observed. ConclusionImproving medical knowledge of AWD is a way to make this complication even more uncommon.

Delayed-onset delirium tremens – a diagnostic and management challenge

Delirium tremens (DT) is one of the most serious complications of alcohol withdrawal, affecting 5-10% of in-patients with a mortality rate up to 15%. DT, characterised by delirium and tremors, appears within 48-72 h of abstinence and persists for about 5-10 days. We report a case of DT in a young man with delayed onset on the 15th day after the cessation of alcohol use, despite an uncomplicated detoxification with benzodiazepine treatment. We hypothesise that the intake of country liquor in our patient, which contains higher percentages of alcohol, causes a prolonged imbalance of N-methyl-d-aspartic acid and glutamate receptor activity, leading to the picture of delayed-onset DT and that an atypical presentation at the time of admission and atypicality in early course are clinical pointers to the subsequent development of delayed-onset DT.

The A9 allele of the dopamine transporter gene increases the risk of visual hallucinations during alcohol withdrawal in alcohol-dependent women

Previous studies have found an association between the A9 allele (nine-copy repeat) of the dopamine transporter (DAT) gene and two complications of alcohol withdrawal, namely delirium tremens (DT) and alcohol withdrawal seizures (AWS). Most of these studies only included male alcohol-dependent patients. Even those that included a small proportion of women did not look at the effect of gender. We compared the frequency of the A9 allele in 64 French Caucasian alcohol-dependent women with a history of alcohol withdrawal complications. Women carrying the A9 allele had more visual hallucinations during withdrawal than those without this allele ( P=0.03). However, women with the A9 allele were not more susceptible to DT or AWS than those without ( P=0.48 and P=1.00, respectively). Our results suggest that the A9 allele of the DAT gene is involved in vulnerability to alcohol withdrawal complications in women, but that these complications differ from those associated with this polymorphism in alcohol-dependent men.

Treating alcohol dependence in a district general hospital.

A strategy for managing alcohol problems within the general hospital setting should involve improved recognition of acute physical complications of alcohol withdrawal and dependence. Research shows that opportunistic interventions at this stage can reduce alcohol consumption by 25% in excessive drinkers. Support should be available from a local community alcohol service.

Care and Management of the Chemically Dependent Patient Withdrawing from Alcohol: An Evaluation

Hospitalized medical and surgical patients with the progressive and fatal disease of alcoholism often experience serious complications during the withdrawal process. The lack of clear established standards, specific to the complications of alcohol withdrawal, compromise the care and management of the chemically dependent patient. Given the high costs of acute hospital beds, the importance of identifying and treating patients experiencing alcohol withdrawal is crucial. In our study, a systematic, multi-disciplinary approach to the management of these patients was implemented following a comprehensive training program. A quasi-experimental design with a nonequivalent control group was used to assess the differences between two hospital sites serving orthopedic trauma patients. Researchers examined the outcome of using this systematic approach in areas of length and degree of withdrawal, obstructive behavior, nursing job satisfaction, change in the knowledge level of the nurses, and patient's choice of commu...

Impact of Age on the Severity, Course, and Complications of Alcohol Withdrawal

Early identification of alcohol-dependent patients at increased risk for severe or complicated alcohol withdrawal would improve triage and treatment. However, the role of age in predicting alcohol withdrawal outcomes has not been well studied. To assess the impact of age on the severity, course, and complications of alcohol withdrawal. We performed a retrospective cohort study of 284 inpatients admitted for alcohol withdrawal between September 1992 and August 1994. Outcomes included alcohol withdrawal severity measured by the revised Clinical Institute Withdrawal Assessment for Alcohol scale, quantity and duration of benzodiazepine therapy, and complications during withdrawal. Initial and maximal withdrawal severity scores, amount of benzodiazepine administered, and duration of benzodiazepine treatment for elevated withdrawal severity scores did not change significantly with age. However, patients aged 60 years and older had increased risk for delirium (adjusted odds ratio [OR], 4.7; 95% confidence interval [CI], 1.5-15.0; P = .008), falls (OR, 3.1; 95% CI, 0.9-11.2; P = .08), and transient dependency in 2 or more activities of daily living (OR, 5.8; 95% CI, 2.9-11.7; P < .001). As age increased, there were significant increases in length of stay (P < .001) and frequency of discharge to an extended care facility (P < .001). Although alcohol withdrawal severity scores and benzodiazepine requirements were similar across age groups, patients aged 60 years and older were at increased risk for cognitive and functional impairment during withdrawal. These findings support recommendations that older patients with alcohol withdrawal are best treated in closely supervised settings.

Impact of age on the severity, course, and complications of alcohol withdrawal

Impact of age on the severity, course, and complications of alcohol withdrawal

Chlormethiazole or chlordiazepoxide in alcohol detoxification

The alcohol withdrawal syndrome is characterised by symptoms such as anxiety, insomnia, anorexia, nausea, tremor, sweating and disturbances in coordination. These symptoms tend to occur within 6 to 12 hours of alcohol-dependent patients stopping or reducing their alcohol intake. Less frequently, convulsions, hallucinosis and delirium tremens can occur. Delirium tremens (disturbed orientation, visual and auditory hallucinations, paranoid ideation and tremulousness) is the most serious complication of alcohol withdrawal and occurs in up to 5% of patients withdrawing from alcohol. If it is severe or poorly treated, death can occur. In the UK some clinicians use chlormethiazole while others favour chlordiazepoxide. This article will examine and compare the use of these two drugs.