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How to Treat Alcohol Withdrawal Delirium?


Things to note:
  • For physical and environmental support, hospitalization is required.
  • Control acute disruption.
  • Laboratory tests / medical investigations indicating the exclusion or diagnosis of a underlying medical problem, the primary treatment of which is delirium diagnosis.
  • In addition: Monitor signs of vital importance regularly. Cardiac monitoring and oximetry for high doses of benzodiazepines should be used.
  • Correct dehydration and electrolyte abnormalities and nutrition.
  • Consider parenteral fluids to offset severe losses, in other words In hyperthermic conditions.
  • Consider meningitis in febrile patients as part of the difference diagnosis.
  • Consider reference to the formal withdrawal and rehabilitation program for appropriate patients.

Medical Treatment:
Symptom- triggered regimens are related to a lower total dose of medication and a shorter total hospital stay. Drug doses depending on the severity of symptoms.
Uncomplicated withdrawal
In case of uncomplicated withdrawal, alcohol detoxification can be managed on an ambulatory basis.
  • Thiamine, oral, 14 days, 100 mg daily.
AND
Diazepam, 10 mg directly, orally.
  • Then for 3 days 5 mg 6 hourly.
  • Then for 2 days, 5 mg 12 hourly.
  • Then for 2 days, 5 mg daily.
  • Then stop.
Benzodiazepines, e.g:
Slow IV diazepam, 10 mg( not IM).
  • If necessary, repeat the dose after 5-10 minutes.
  • Use 10 mg every 5- 10 minutes for a further 1- 2 doses if this dose is not sufficient.
  • If the patient has not yet been sedated, continue to take 20 mg doses until this happens.
OR
Where a single dose of intravenous access is not possible :
  • Clonazepam, IM, 1-2 mg.
    • If no answer, repeat 60 minutes later.
    • Daily maximum dose: 10 mg.
OR
  • Lorazepam, IM, 1- 4 mg every 30- 60 minutes before sedation of the patient.
    • Repeat hourly doses to sedate mildly.
    • Daily maximum dose: 6 mg.
Once the patient has been sedated, i.e. light somnolence, keep sedation mild with:
  • Diazepam, oral, 5-20 mg 2-6 hours.
CAUTION
  • Benzodiazepines may cause respiratory depression, in particular diazepam IV. Close monitoring of patients as benzodiazepines can exacerbate an abnormal mental state or mask important neurological deterioration signs.

Neuroleptic drugs, i.e. Medicines like haloperidol are associated with a lower threshold for seizure. Consider only severe restlessness and agitation and in combination with one of the above sedative- hypnotic agents.
  • Haloperidol, 0.5- 5 mg IV / IM.
    • Repeat to a maximum of 20 mg daily after 4-8 hours.
Once the patient has responded and is able to take oral medication:
  • Haloperidol, oral, 4-8 hours of 0.5-5 mg.
  • Thiamine, oral / IM, 100 mg daily when glucose- containing fluids are given.