How much lorazepam have you given....

manncer · Feb 5, 2010

Lorazepam acts on GABA receptors in the brain, just like alcohol, so huge alcohol tolerance reflects in Ativan dosing. :idea:

yliurn · Feb 5, 2010

Lorazepam acts on GABA receptors in the brain, just like alcohol, so huge alcohol tolerance reflects in Ativan dosing.

Glad to know:lol2:

CABGx4, ASN, BSN, MSN, CRNA · Mar 20, 2010

etoh/drug withdrawls= my least favorite patients.

WalkieTalkie, RN · Mar 20, 2010

We once had a patient who was getting a ridiculous amount of Ativan down his NG tube (like 40 mg Q8), and like 8 mg IV every hour. Oh, and in addition to that, he was on a Versed gtt at about 16 mg/hr, AND propofol! I nearly emptied the Pyxis of Ativan every time I had to give it to him!

The guy was an alcoholic and also weighed about 350 lbs. He wasn't even snowed with this amount. Just slightly sedated... WOW...

APNgonnabe · Mar 20, 2010

Off the lorazepam but...is anyone using precedex for ETOH wd? And holy cow I can't believe (i really can) how much people have to give!!

WindwardOahuRN, RN · Mar 21, 2010

Off the lorazepam but...is anyone using precedex for ETOH wd? And holy cow I can't believe (i really can) how much people have to give!!

Precedex? Really? Never used it for ETOH. Just lots of benzos. Four point restraints, min stim, and benzos. Propofol too in addition to the benzos. MASSIVE benzos and whatever you do don't let the gtt run dry.

I've seen very mixed results with Precedex (never seen it used for ETOH so I can't comment on that). Some patients react as if they are in a semi-zombie state, which I guess is okay as long as they are with the program, and with others it doesn't seem to work at all even at max infusion rate. We start Precedex while the other gtts are still running and wean the others gradually before extubation is planned but I just find Precedex to be so unpredictable in its actions.

We continue the Precedex for a while after extubation but sometimes I just wonder why we bother.

Anyone else here have opinions/experiences related to Precedex?

emt123277 · Mar 22, 2010

Answering your Librium question, I was dosing 25mg q 2hrs and the pt didn't even slow down.

RN-ing, BSN, MSN, NP · Mar 24, 2010

Precedex? Really? Never used it for ETOH. Just lots of benzos. Four point restraints, min stim, and benzos. Propofol too in addition to the benzos. MASSIVE benzos and whatever you do don't let the gtt run dry.
I've seen very mixed results with Precedex (never seen it used for ETOH so I can't comment on that). Some patients react as if they are in a semi-zombie state, which I guess is okay as long as they are with the program, and with others it doesn't seem to work at all even at max infusion rate. We start Precedex while the other gtts are still running and wean the others gradually before extubation is planned but I just find Precedex to be so unpredictable in its actions.
We continue the Precedex for a while after extubation but sometimes I just wonder why we bother.
Anyone else here have opinions/experiences related to Precedex?

Most of our CABGs come back on Precedex while intubated and we can usually leave it on after extubation. Actually seen it used on a couple combative and confused elderly patients; it worked really well. Pts slept all night and woke up calm when stimuated. Never seen it used on ETOH though.

hypocaffeinemia, BSN, RN · Mar 24, 2010

Precedex isn't good for ETOH considering right now it's only on-label use is up to 24 hours.

sassyrn333 · Mar 27, 2010

I've used Precidex for ETOH w/d on 2 different occasions because the Docs didn't want to start an ativan gtt for fear of over sedating. But I thought that one of the benefits of working in the ICU....just make the dude unconscious and intubate him and everyone wins!

sagwaltn · Mar 30, 2010

My unit has used ativan IV 2mg q2h with a continuous low dose precedex drip titrated to patient response without having to be put on mechanical vent.

CCRNblahblahblahRN · Apr 19, 2010

The highest we titrate ativan gtts is 15 mg/hr, saw a pt who got 28 mg in an hour and was still fighting....lately have been using dexmedetomidine (precedex) gtts to wean down ativan with success. Also have found that giving small doses (1 mg prn q3hr) of dilaudid helps to decrease amt of ativan given. Sometimes ativan for withdrawal with propofol for sedation has worked, each pt is different and sometimes the things that work are head-scratchers. Worst case I saw was a post-op on 50mcg/kg/min propofol 18 mg/hr ativan 5mg versed IV bolus 2 mg dilaudid still doing high kicks over the bedrails (and yes, the TLC was confirmed by CXR) unbelievable!