Alcohol Withdrawl

We have a high, med, and low dose protocol. It uses ativan and haldol. It's nice 'cause it's easy to tweak the numbers if you really feel they need ativan, but they aren't quite making the grade.

One of our ortho Docs prescribes booze for pts who are heavy drinkers to keep them from ending up in the ICU with DT's after a knee replacement.

Ive medicaly detoxed pts in ICU, on the floor, and in a nonmedical detox.

I believe that detoxing from ETOH is probably the hardest of all substances and can kill. After a couple of days rest the meth and heroin addicts would get up and walk away.

In the unit Im in now we use diazepam. In a tele unit I worked in they used ativan.

In the nonmedical detox they just shaked and baked. Usually start to seize at around 48 hours. We would encourage candy to keep their blood sugar up. Not sure if that is wise or not.

Either way a detox is going to be hard. But it doesnt stop them from going back for more, even after failed liver and kidney txps.

I personally dont recommend using ETOH but then again I am not a prescriber-

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Had a medical doctor use Buprenex for detox. Did not work as well as po Librium. He used it for a long while but finally went back to ativan, librium, and vitamins.

Mainly, we use an IV banana bag, Ativan or Valium, and Librium. We also do frequent neuro checks to determine how badly they're having DT's and how effective their medication is.

I found that using a flow sheet similar to this helps me to describe s/s to the doc if my assessment determines that we need increased medications or even a transfer to a higher level of care.

http://www.ciap.health.nsw.gov.au/hospolic/nursdap/maindoc3.html#LOCE10E8

The ICU I worked in the past used Propofol drip. We used that for 3 to 5 days and titrated to effect, ie still breathing and not fighting demons. We never lost a patient to cardiac problems due to increased oxygen needs during withdrawal. Very short half-life anesthetic agent, we called it 'milk of amnesia', used properly it can do the job.

we've used valium, haldol and the b vitamins.

Valium 20 mg as per withdrawal scale I've seen it given a max of 200 mg in 24 hrs.

Ativan 2 mg as per withdrawal scale for clients with liver problems.

and lastly we also give Thiamine injections one time or tablets 100mg for three days

Thanks for all of the replies..it sounds like we do pretty much what everyone else does...haldol/ativan/librium/vitamins

I think that we are also going to be trying valium...

I work in CCU and it sure is a shame when your second day post cardiac surgery patient starts with the DTs...

If anyone else has ideas, I would love to hear them...

Thanks!

Hi, I'm currently a pre-nursing student (will begin my nursing program in May) and I'm wondering why alcohol withdraw can be fatal vs. other drugs. I've been following this thread and find this very interesting.

Thanks!!

You are using some form of the CIWA scale with sliding scale benzos, right?

I did psych consultation-liaison at a big teaching hospital a few years ago, and our team managed withdrawal throughout the house under the supervision of our certified addictionologist. For ETOH, we used B vitamin replacement (extremely important for preventing permanent neuro damage), with scheduled doses of Ativan plus sliding scale Ativan based on CIWA results q 2 hours for the first couple days (round the clock! -- it's really a problem to have the noc nurses skip the assessment all night because the patient's asleep, then have the patient wake up in the AM in DTs! ...), then q 4 hours for a couple days We did not use Haldol (creates more problems than it solves), and lots of detox/addictions people avoid using Valium because of its v. long half-life. We rarely had people get into serious trouble on this regimen. Ativan can be given q 1 hour if q 2 isn't frequent enough to keep them maintained.

One of the big issues is assessment -- identifying early anyone who might be at risk of going into withdrawal, and starting them on the protocol prophylactically before they do so.

I have occasionally seen orders for someone to have alcohol to drink daily while in the hospital, because they didn't want to be detoxed and would be at risk of withdrawal if they were cut off abruptly. It's up to the attending to make that call. If they are not already in withdrawal when they arrive (i.e., it's not an emergency situation), they have the same right to refuse detox that they do to refuse any other treatment.

ETOH withdrawal, unlike opiates or most other recreational drugs, is considered a life-threatening emergency, and can easily be fatal.

Thanks for your response...While I don't know exactly what the CIWA scale stands for...we use a protocol similar to what you have mentioned...with the B Vits/ lots of ativan as needed/ and the librium...Thankfully we only get the serious cases few and far between but when we do get them, it is somewhat unfamiliar territory (especially after their cardiac surgery)...If we know the person drinks we do start them on the protocol before they have problems...however we recently did have one that turned out with not so good results, many of the rns feel that since the patients stay was emergent, that we should have also tried addiding in some alcohol to drink while hosptialized since he wasn't ready to quit (and still had lots to learn about his very new cardiac issues)....It was just a bad combo all together but we all realize that we need to bone up on the current care for this type of patient....

Well, in our unit, it just depends. For the ones that we detox, we use a routine dose of ativan with prn ativan to back it up, we've also used propofol, we've added valium, haldol, etc. when needed and of course all the b vitamins and folic acid.

HOWEVER, there are times when we say why bother and we just give them beer. Actually just had a pt. not too long ago that was ordered 2 beers TID. He was basically end of life anyway, so why bother detoxing him? We also realize that when some people leave they're not gonna stop drinking, so may as well just give it to them and save the risks of d/t's. For those of you who have never seen someone die from detox (I saw it before I was a nurse, when I was in law enforcement), trust me, it DOES and CAN happen!!!!!

Let me tell you, there's nothing more fun than a neuro patient who's also in d/t's!!!

Also, we're in the process of writing the protocol for alcohol gtts. So, we'll be using that VERY VERY soon.

Hope this helps!