Alcohol Withdrawl

[NeuroICURN]

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!

[PMHNP10]

Just curious to see what type of protocol others are using for their patients that go into acute alcohol withdrawl/ DTs after being admitted to the hospital for another problem.

We do have a withdrawl protocol but many of us feel that it does not work as well as it could. Typically we use IV ativan, PO libirum and add mutlivits, etc to the patient's daily IV fluids- or PO if they are taking it. We are going to talk to our behaviorial health unit and see what protocols they use as well...just getting a feel for the current things others are doing...

Is anyone giving their patients actual alcohol (I ask this because when we get patients going through withdrawl- I am pretty sure that they are not withdrawling by choice...mostly they end up in my unit as an emergent kind of thing and haven't dealt with everything else that goes along with quitting...and we aren't going to make them stop)

Thanks in advance!!

We use AWS (alcohol withdrawal scale) to treat withdrawal. The doctor chooses from diazepam, chlordiazepoxide, oxazepam, or ativan and usually orders MVIs, thiamine, and folic acid as well. The benzo is then administered based on a score determined from objective and subjective data. The score on the scale also determines frequency of assessment of withdrawal symptoms which can range from Q1H to Q6H.

[NewEastCoastRN]

we use a serax taper and IV ativan as needed. banana bags are usually given as well.

[medpsychRN]

I would be wary of using alcohol to help detox or avoid withdrawal. Symptoms of withdrawal begin once the blood alcohol level halves. Patients with a high tolerence will begin to show withdrawal despite being legally intoxicated. Thus, six oz. of alcohol a day is not enough to prevent withdrawal problems. The best course of treatment is to use the CIWA scale and medicate with a short acting benzo.

[teeituptom, BSN, RN]

I miss the old days when we used to use paraldehyde and antabuse

[chaosRN, ASN, RN]

We use ativan & haldol. We also give the QD dose of B-vitamins & folic acid. I have seen an ETOH gtt (I don't remember the concentration only that is was a realy BIG bottle!! ). Only used it once though. Anyone else seen this?

[Gail-Anne]

Our facility uses ETOH gtt often for people post-surgery for neck cancers. This is not the time for detox, withdrawal vomiting, shakes etc. I'm also old enough to have used LOTS of paraldehyde when I worked a unit that included detox. The big advantage over Valium (esp IV) was that it didn't have the same effect on the lungs of those heavy smokers. We also put our detox pts on Dilantin, sure cut back on seizures. We'd start tapering after a few days. Is that not done anymore?

[medpsychRN]

Saw an alcohol drip many years ago following surgery. Guy went into DT's (before the alcohol drip). In regards to Dilantin, regardless if within therapeutic range, they'll seizure anyway. Benzo's usually prevents the seizure.

[Quailfeather]

We use pretty much the same protocol that I have seen mentioned here. I remember back in the days when we had no such protocols. As a matter of fact, it seemed that MD's rarely screened for potential alcohol dependency back in the 80's and early 90's. I recall one time we admitted a TV celebrity for some fractured ribs and the doctor never addressed this guy's drinking history. The next day the "whips and jingles" set in and the guy broke a nurse's arm before they figured out what was wrong with him. Alcohol withdrawal is dangerous for the caregivers, as well as the patient.

[curleysue]

My sister workes at a VA vet hospital where the doctors do order beer occationally for the alcoholic who gets it on their lunch and dinner trays or whenever its ordered.

My thinking on one of the posts someone said they used propofol to put them in a kinda rapid detox. Isnt' that defeating the purpose of withdrawl. Sure its an easy way out for the patient but what lesson is learned? Same with any withdrawl. I beleive in medication to a point of helping the severe physical withdrawl that can be dangerous including seizures and vitamin deficiencies or malnutrition. But I also think withdrawl should be very hard on a patient so that maybe they will say "that was the hardest thing I have ever had to go through, I will never ever to that again!"

Just a thought. Curleysue

[teeituptom, BSN, RN]

My sister workes at a VA vet hospital where the doctors do order beer occationally for the alcoholic who gets it on their lunch and dinner trays or whenever its ordered.

My thinking on one of the posts someone said they used propofol to put them in a kinda rapid detox. Isnt' that defeating the purpose of withdrawl. Sure its an easy way out for the patient but what lesson is learned? Same with any withdrawl. I beleive in medication to a point of helping the severe physical withdrawl that can be dangerous including seizures and vitamin deficiencies or malnutrition. But I also think withdrawl should be very hard on a patient so that maybe they will say "that was the hardest thing I have ever had to go through, I will never ever to that again!"

Just a thought. Curleysue

Unfortunately it has never worked that way

What did it for me was after one night of heavy drinking I woke up naked next to the biggest fattest ugliest woman with stretch marks and sores all over her body. That did it for me. Havent drank since.

[rnmi2004]

As has been mentioned on this thread, alcohol withdrawal can be fatal. So you can't really just let it happen & hope they'll learn their lesson.

Yikes, tom--that would have cured me too, as well as ticked off my dh. Maybe we should call you "Teetotalertom?" :chuckle