Management Of Acute Alcohol Withdrawal Research Articles

Medical Management of Acute Alcohol Withdrawal in Hospitalized Patients at a Community Based Network of Hospitals: A Retrospective Cohort Study

Medical Management of Acute Alcohol Withdrawal in Hospitalized Patients at a Community Based Network of Hospitals: A Retrospective Cohort Study

Managing acute alcohol withdrawal with Homoeopathy: A prospective, observational, multicentre exploratory study

Background: Alcohol dependence is a common social problem which may be associated with other risk factors and co-morbidities. Abrupt cessation of alcohol intake may provoke an acute alcohol withdrawal phase with varying degrees of signs and symptoms. In conventional medical system, specific pharmacological interventions are used for management of Acute Alcohol Withdrawal (AAW). There exists a need to explore safe and holistic treatment of AAW. The present work reports the results of a prospective, observational, exploratory, multicentre trial (2008-2011) to assess the role of Homoeopathy in AAW. Materials and Methods: Individualised Homoeopathy was given to 112 patients reporting with AAW. The clinical assessment was done for 05 days using Clinical Institute Withdrawal Assessment Scale of Alcohol-Revised (CIWA-Ar). Post-withdrawal phase, quality of life of patients was assessed at end of 01 st , 03 rd and 06 th month using World Health Organisation quality of life (WHOQOL)- BREF. Results and Analysis: There was a significant decrease in CIWA-Ar mean scores and increase in quality of life score (P < 0.001). The most common remedies used were Arsenicum album, Lycopodium clavatum, Belladonna, Nux vomica and Pulsatilla. Conclusion: The results of current observational pilot study suggest the promising use of Homoeopathy in the management of acute alcohol withdrawal. Further studies with large sample size and rigorous design are warranted.

Lack of Efficacy of Dextromethorphan in Managing Alcohol Withdrawal

Alcohol withdrawal syndrome is associated with increased central N-methyl-D-aspartate (NMDA) glutamate transmission. Medications that reduce glutamate release or block NMDA overactivation have shown efficacy for treating alcohol withdrawal syndrome. Dextromethorphan (DXM), a widely used antitussive drug, is a low-affinity, noncompetitive NMDA antagonist with potential neuroprotective properties. This study, using a randomized, double-blind, placebo-controlled study design, examined the benefit of DXM in the management of acute alcohol withdrawal. Alcohol-dependent patients admitted for detoxification treatment and experiencing moderate alcohol withdrawal, as measured by a score greater than 10 on the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), were randomly assigned to receive either DXM 360 mg/d or an identical placebo for 7 days in a double-blind manner. All subjects received a concurrent dose of lorazepam 2 mg along with the initial administration of DXM or placebo and were given additional lorazepam (1 mg) as a rescue medication according to the symptom-triggered detoxification protocol. Outcome measures consisted of the mean total dose of lorazepam received, the sequential scores on the CIWA-Ar, and craving assessed by the Obsessive-Compulsive Drinking Scale. Forty subjects completed the study, 18 in the DXM group and 22 in the placebo group. We found that compared with placebo, DXM use was not associated with lower lorazepam doses to control alcohol withdrawal symptoms. The progression in CIWA-Ar and Obsessive-Compulsive Drinking Scale scores was also comparable between the 2 groups. Our preliminary results do not support the efficacy of high-dose DXM in reducing the need of benzodiazepines to treat withdrawal symptoms in alcohol-dependent patients.

Management of acute alcohol withdrawal in the setting of a quick diagnostic unit integrated in an emergency department setting

Background Alcohol consumption can have adverse social, legal, occupational, psychological, and medical consequences. The prevalence of alcohol-use disorders is high in Emergency Departments. The novel establishment of a Quick Diagnostic Unit (QDU) in an ED setting has allowed expeditious and focused, medically supervised acute alcohol withdrawal. The purpose of the study was to describe the alcohol-use disorder clientele and treatment in this new setting.

Assessment and management of alcohol dependence and withdrawal in the acute hospital: concise guidance

Alcohol dependence is common among patients attending acute hospitals. It can be the major reason for attendance or a significant cofactor. Assessment of these patients in the acute setting can be challenging owing to the multidisciplinary approach required. Doctors in acute hospitals are often inexperienced in managing dependence, a mental health problem. They might focus on the physical harms or the withdrawal, a consequence of the dependence. For this reason, assessment of dependence and prevention and management of acute alcohol withdrawal are often suboptimal. There is little existing guidance on how to manage this patient population, especially in non-specialist settings. With recently published National Institute for Health and Clinical Excellence (NICE) guidance on the management of dependence and withdrawal, now is the perfect time to produce concise guidelines in the hope that a more succinct suite of guidance can reach a larger audience.

OC-030 Benefits of introduction of a symptom triggered regimen for management of alcohol withdrawal in a large teaching hospital trust: reduced admission duration and cost savings

IntroductionAcute alcohol withdrawal (AAW) is an increasingly frequent cause for hospital admission in the UK. NICE guidance (2010) recommends the use of a symptom triggered regimen (STR) rather than a...

Review of the management of acute alcohol withdrawal

NICE is a British organization, the National Institute for Health and Clinical Excellence, which reviews the evidence for the diagnosis and management of many different clinical conditions. The guidelines produced are based on the evidence found in the international literature and are used in the UK as a baseline for excellent clinical practice.In this journal we will give summaries of topics covered by NICE, together with some tips on how you may need to adjust them based on the local realities in Nepal. You can access the full guidelines yourself by going to: www.nice. org.uk

Utilisation of a purpose-designed chart for the nursing management of acute alcohol withdrawal in the hospital setting

Summary Objective To describe nursing utilisation of a purpose-designed alcohol withdrawal management chart in terms of completeness of recording assessment measures, and use of recommended dose of diazepam and observation intervals. A secondary objective was to compare utilisation between the emergency department short stay ward and hospital wards. Methods A retrospective review was performed on data collected on a standardised chart for management of alcohol withdrawal. The convenience sample was 200 consecutive patients admitted through the emergency department from October till December 2007 and placed on the alcohol withdrawal chart. Assessment items, drug doses, observation intervals and admitting ward were recorded. Deviations from recommendations were calculated. Results A total of 3096 assessments were recorded. There was 85% compliance in completing assessment items and 84% compliance with recommended dose of diazepam. Incomplete assessments were mainly due to the patient being sleeping or because the patient's temperature was not recorded. There was similar performance between the short stay ward and hospital wards. Compliance with observation intervals was much lower at 49%, with observations being made early as well as late. Conclusions High compliance was achieved with the assessment tool and dosing regime, but not with recommended observation intervals. High compliance may be related to the brevity and standardisation of assessment and use of a single page format but requires further study.

Valproic Acid Management of Acute Alcohol Withdrawal

To review the clinical evidence to determine the efficacy and safety of valproic acid in the management of alcohol withdrawal syndrome (AWS). MEDLINE (1966-February 2006), EMBASE (1980-February 2006), and PubMed (1966-February 2006) searches identified pertinent studies that were conducted in humans and published in English. Key words used for identification of articles included valproic acid, ethanol, alcohol, alcoholism, alcohol withdrawal delirium, alcohol withdrawal seizures, and substance withdrawal syndrome. References of identified articles were manually searched. All controlled clinical trials that evaluated the use of valproic acid for the management of AWS in humans were included. Comparisons were made among various regimens of valproic acid and traditional therapy with benzodiazepine or nonbenzodiazepine agents. Only 2 of 6 trials reported a statistically significant difference in favor of valproic acid on endpoints of AWS. However, these differences were of marginal clinical significance. The number of patients included in these studies did not allow for adequate evaluation of safety. The existing limited efficacy and safety data suggest that valproic acid should not replace conventional therapy or be used as adjunct therapy for management of mild-to-moderate AWS.

Management of Acute Alcohol Withdrawal in the Inpatient Setting

Collaborative drug therapy management (CDTM) is a method for developing a patient-centered practice in which the pharmacist's activities are integrated with those of other health care providers. The goals of this continuing feature are to refine the concept of CDTM and provide patient-care applications from the authors' experience in Washington state. Questions or suggestions should be addressed to Timothy S. Fuller, FASHP, Fuller and Associates, 1948 Boyer Avenue East, Seattle, WA 98112-2924 (tel.206-860-8308). E-mail: timfuller@kendra.com

A Pilot Open Randomized Trial of Valproate and Phenobarbital in the Treatment of Acute Alcohol Withdrawal

The authors conducted a randomized, open comparison of the GABAergic anticonvulsant sodium valproate (divalproex sodium; Depakote) and phenobarbital as an active control in the management of acute withdrawal from alcohol. Repeated measures ANOVA was used to assess treatment effects in the first 37 inpatients, evaluating mood, hostility, and subjective and objective measures of withdrawal at index, 3, and 5 days of detoxification. Subjective and objective ratings of abstinence symptoms and subjective mood disturbance decreased significantly in intensity in both groups over 5 days, but there were no significant treatment differences nor treatment by time interactions. Hostility scores did not differ overall, but a group by time effect was observed (F = 5.42, df=[1,13], P&lt;0.05), with phenobarbital subjects reporting less hostility/ aggression than those in the valproate group. There were no withdrawal‐related seizures or other acute sequelae. This study offers pilot confirmation that sodium valproate is as effective as phenobarbital in the management of acute alcohol withdrawal, but it is unclear whether valproate offers a clinical advantage with respect to stabilizing changes in mood and interpersonal hostility during detoxification.

THE MANAGEMENT OF ALCOHOL WITHDRAWAL USING CHLORMETHIAZOLE

Chlormethiazole is an extremely useful and flexible drug for use in the management of acute alcohol withdrawal. It is not a treatment for alcohol abuse and should not be used in this patient group, other than in the withdrawal period, and then for less than 10 days. It is extremely safe when used correctly by practitioners familiar with its properties. Problems can arise, however, if used by practitioners unaware of its limitations and the precautions needed for safe prescribing.

Impact of Clonidine on Alcohol Withdrawal States-Reply

In Reply. —We would like to thank Dr Stock for his comments on our study. In no way did we wish to imply immediate implementation of clonidine in the management of acute alcohol withdrawal. However, we wish to reiterate our conviction that further research with clonidine for this use is warranted as suggested by our results. We agree that the assessment of specific subjective complaints of alcohol withdrawal has not been standardized. A logistical problem, this is also seen in other detoxifications, as we suggested with our comparisons to opiate withdrawal. 1 Standardization of objective clinical assessments for alcohol withdrawal has been suggested by Sellers et al, 2 with some agreement. At our institute, we have adopted the Alcohol Withdrawal Scale (AWS) of Cushman et al, 3 which we recommend for all controlled trials of this type in an attempt to standardize methodology in this area. The AWS is not

Hospital Admissions From a Non‐Medical Alcohol Detoxification Unit

AbstractTransfers from an inner city, social setting alcohol detoxification unit to its parent hospital were examined for a 33 month period. 51 (1.2%) out of 4192 admissions during this period were subsequently transferred to hospital. 21 (43%) were for the management of acute alcohol withdrawal, representing 0.5% of total admissions to the detoxification unit. Analysis of transfers indicates that the unit provides a safe detoxification environment and process.

Management of acute alcohol withdrawal

The relationship between maxillofacial trauma and alcohol abuse has been well documented. The onset of acute alcohol withdrawal following the injury can seriously complicate and compromise the treatment of the maxillofacial injuries as well as be potentially lethal for the patient. A clear understanding of the biochemistry, development, signs and symptoms, and management of acute alcohol withdrawal is necessary for the oral and maxillofacial surgeon.