title: Alcohol withdrawal requiring massive prolonged benzodiazepine infusion.
abstract: The objective of this case report is to describe a patient with prolonged alcohol withdrawal requiring massive standing doses of benzodiazepines. The setting is the medical intensive care unit of the Tripler Army Medical Center, Honolulu, Hawaii. The patient is a 58-year-old alcohol-dependent male presenting with mental status changes and agitation following an uncomplicated cystoprostatectomy, who ultimately required massive doses of benzodiazepines to treat his symptoms effectively. We conclude that symptom-triggered therapy proved ineffective in this case due to inability to achieve adequate frequency of assessments. Ultimately, a lengthy, high-dose, fixed interval benzodiazepine regimen was required. The 5-week period of intensive care illustrated that scheduled doses of benzodiazepines may be required and massive and prolonged doses are sometimes necessary. Adherence to a slow-weaning protocol understood by an interdisciplinary team was critical to this patient's recovery. Additionally, toxicity from the high-dose medication was not observed.
authors.affiliation: Department of Psychiatry, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Hayes
authors.forename: Paul M
authors.initials: PM
authors.lastname: Faestel
authors.forename: Paige L
authors.initials: PL
authors.lastname: Shimamoto
authors.forename: Craig
authors.initials: C
authors.lastname: Holland
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy*; D020751:Alcohol-Induced Disorders; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D006254:Hawaii; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D008890:Military Psychiatry; D013997:Time Factors; D014481:United States
chemical_list: D001569:Benzodiazepines