Alcohol Withdrawal Syndrome: Improving Outcomes in the Emergency Department With Aggressive Management Strategies - Pharmacology EXTRA Supplement

Points & Pearls Excerpt

• After assessing ABCs, management of AWS begins with an assessment of the severity of the alcohol withdrawal. The presence of tachycardia, hypertension, diaphoresis, agitation, and/or seizure activity (or history) suggests severe withdrawal.
• Obtaining an ethanol level is recommended, as severe alcohol intoxication can mimic alcohol withdrawal in some individuals. Individuals who have alcohol withdrawal with an elevated ethanol level are more likely to develop severe AWS.
• Benzodiazepines are first-line medications for management of most cases of mild, moderate, and severe alcohol withdrawal symptoms; no other drug class has been shown to be superior.
• Diazepam’s clinical effects occur in 1 to 5 minutes, with a long half-life of 48 hours and active metabolites, including nordiazepam and oxazepam, that extend the duration of the desired sedative effects.
• For AWS refractory to 200 mg of diazepam in 4 hours or AWS requiring a single dose of diazepam ≥40 mg, escalating the dosing every 15 minutes is recommended and supported by case-control literature.