Treatment of Alcohol Withdrawal
You treat a patient with alcohol withdrawal after the patient has been diagnosed as being in alcohol withdrawal, with symptoms (i.e. CIWA score ≥8). Patients usually have a history of heavy alcohol use with their last drink within the last 6-48 hours.
Prophylaxis of Alcohol Withdrawal
Prophylaxis, on the other hand, is given to people who have minimal or no symptoms (i.e. CIWA score < 8) to prevent them from developing alcohol withdrawal. You give this only to people with high-risk factors for withdrawal.
Who should get prophylaxis? Asymptomatic or minimally symptomatic patients (i.e. CIWA score < 8) with high-risk factors for alcohol withdrawal.
Patients at high risk for alcohol withdrawal include patients with a:
- History of withdrawal seizures
- History delirium tremens, or
- Prolonged, heavy alcohol consumption
Patients with these risk factors admitted to the hospital for other reasons should be prophylactically treated with oral chlordiazepoxide.
Chlordiazepoxide 25-100 mg q6h x 24hrs, then 25-50 mg q6h x 2days. The dose is based on the severity of alcohol use.
If more severe symptoms develop on a patient who is getting prophylaxis with Chlordiazepoxide, the patient should be treated for alcohol withdrawal in the usual fashion.
Monitoring Patients On Alcohol Withdrawal Prophylaxis
Monitor these patients the same as patients in active withdrawal. Reassess frequently. Increase the dose of chlordiazepoxide given each hour if a score of 8 or greater is achieved on the CIWA-Ar
After acute treatment, screen the patient for alcohol dependence. This patient should be considered at risk for recurrent episodes of withdrawal.