Related article: Alcohol Withdrawal Treatment.
Diagnosis
Definition:
Diagnosis is clinical based on hx of heavy alcohol use, abstinence, and now having signs and symptoms consistent with alcohol withdrawal.
H&P (Pertinent H&P findings including med review & key vital signs)
-Common presentation:
-Clinical Manifestations
-Associated Conditions.
-Risk factors: Alcohol Dependence.
-Red flags.
–Complications.
Ddx & Etiology
Diagnostic tests: CBC, CMP, Urine drug screen.
Assess severity/acuity: CIWA-Ar
Treatment
– Do CIWA-Ar for Alcohol Withdrawal
– Start Chlordiazepoxide
Patient in alcohol withdrawal. He has been drinking heavily. Last drink was 12 hours ago. “The patient is now nauseated, miserable, restless, shaky, and sweating, and says he can feel his heart pounding.
No seizures or episodes of delirium tremens.
Contraindications to outpatient treatment include things like: “abnormal laboratory results, absence of a support network, acute illness, high risk for delirium tremens, history of alcohol withdrawal seizure, recent long-term intake of large amounts of alcohol, poorly controlled chronic medical conditions, a serious psychiatric condition, severe withdrawal symptoms, or a positive urine drug screen” ABFM
“Neither fixed nor symptom-triggered dosing of benzodiazepines has been shown to be superior to the other. ”
Reference
Am Fam Physician 2013;88(9):589-595. Outpatient management of alcohol withdrawal syndrome.