Resistant alcohol withdrawal: does an unexpectedly large sedative requirement identify these patients early?
BACKGROUND
While most patients with alcohol withdrawal (AW) respond to standard treatment that includes doses of benzodiazepines, nutrition and good supportive care (non resistant alcohol withdrawal-NRAW), a subgroup may resist therapy (resistant alcohol withdrawal-RAW). This study describes a distinct group of AW patients, their sedative requirements, and hospital courses.


METHODS
Over a period of 6 months, AW patients requiring 50 mg diazepam IV in the first hour were followed. We recorded admission indices and diazepam doses with vital signs at 1, 2, 3, 6, 12, and 24 hours. Patients were considered to have RAW if they required additional sedatives for control of symptoms and/or were having persistent abnormal vital signs despite the physicians' choices of therapy.


RESULTS
Nineteen patients were enrolled; all had similar admission indices. While the 4 NRAW had normal vital signs within 3 hours, all 15 RAW patients had abnormal vital signs; 15 RAW patients required escalating diazepam doses--14 required barbiturates, 7 were intubated, and 5 had hypotension. Comparing groups: interval and total diazepam doses were not different at 1,2, and 3 hours; interval doses at 6 and 12 hours, and total doses at 6, 12, and 24 hours were significantly different.


CONCLUSIONS
RAW patients require large doses of benzodiazepine administration, additional sedatives, and undergo complicated hospitalizations.
Hack
Jason B
JB
New York City Poison Center, NY, NY, USA. hackj@mail.ecu.edu
Hoffmann
Robert S
RS
Nelson
Lewis S
LS
D000328:Adult; D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D003975:Diazepam / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012107:Research Design; D015656:Respiratory Mechanics / Q000187:drug effects; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D003975:Diazepam