title: Alcohol withdrawal.
abstract: Alcohol withdrawal is a common clinical condition that has a variety of complications and morbidities. The manifestations can range from mild agitation to withdrawal seizures and delirium tremens. The treatments for alcohol withdrawal include benzodiazepines, anticonvulsants, beta-blockers and antihypertensives. Although benzodiazepines are presently a first-line therapy, there is controversy regarding the efficacies of these medications compared with others. Treatment protocols often involve one of two contrasting approaches: symptom-triggered versus fixed-schedule dosing of benzodiazepines. We describe these protocols in our review and examine the data supporting symptom-triggered dosing as the preferred method for most patients in withdrawal.The Clinical Institute Withdrawal Assessment for Alcohol scoring system for alcohol withdrawal streamlines care, optimizes patient management, and is the best scale available for withdrawal assessment. Quality improvement implications for inpatient management of alcohol withdrawal include increasing training for signs of withdrawal and symptom recognition, adding new hospital protocols to employee curricula, and ensuring manageable patient-to-physician and patient-to-nurse ratios.
authors.affiliation: Tulane University School of Medicine, New Orleans, Louisiana 70112, USA. anton.manasco@gmail.com
authors.forename: Anton
authors.initials: A
authors.lastname: Manasco
authors.forename: Shannon
authors.initials: S
authors.lastname: Chang
authors.forename: Joseph
authors.initials: J
authors.lastname: Larriviere
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
authors.forename: Marcia
authors.initials: M
authors.lastname: Glass
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D020270:Alcohol Withdrawal Seizures / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D006305:Health Status Indicators; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D058996:Quality Improvement
chemical_list: D000927:Anticonvulsants; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines