“The patient was hallucinating, so I gave him an antipsychotic.”
While antipsychotics are certainly indicated for psychotic hallucinations, the use of antipsychotics in alcohol withdrawal is associated with poorer outcomes.91 It is best to address the underlying pathophysiology of CNS hyperexcitability and utilize a GABAA receptor agonist such as a benzodiazepine.
“The patient’s withdrawal looked mild, so I discharged her with benzodiazepines.”
There are criteria for safe discharge of an alcoholic patient presenting with withdrawal or requesting detoxification: CIWA-Ar score < 8, no history of complicated alcohol withdrawal, no clinical alcohol or drug intoxication, no significant underlying medical or psychiatric comorbidities. Even in patients who develop DT, early symptoms may be mild.
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