62 Alcohol Withdrawal
BUY
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-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Flumazenil (Romazicon) 0.2 mg (2 mL) IV over 30 seconds q1min until a total
dose of 3 mg; if a partial response occurs, continue 0.5 mg doses until a total
of 5 mg. Flumazenil may help reverse hepatic encephalopathy, even in the
absence of benzodiazepine use. Excessive doses of flumazenil may
precipitate seizures.
-Multivitamin PO qAM or 1 ampule IV qAM.
-Folic acid 1 mg PO/IV qd.
-Thiamine 100 mg PO/IV qd.
-Vitamin K 10 mg SQ qd for 3 days if elevated INR.
11. Extras: CXR, ECG; GI and dietetics consults.
12. Labs: Ammonia, CBC, platelets, SMA 7&12, AST, ALT, GGT, LDH, alkaline
phosphatase, protein, albumin, bilirubin, INR/PTT, ABG, blood C&S x 2, hepatitis
B surface antibody. UA.
Alcohol Withdrawal
1. Admit to:
2. Diagnosis: Alcohol withdrawals/delirium tremens.
3. Condition:
4. Vital signs: q4-6h. Call physician if BP >160/90, <90/60; P >130, <50; R>25,
<10; T >38.5
C; or increase in agitation.
5. Activity:
6. Nursing: Seizure precautions. Soft restraints prn.
7. Diet: Regular, push fluids.
8. IV Fluids: Heparin lock or D5 1 NS at 100-125 cc/h.
9. Special Medications:
Withdrawal syndrome:
-Chlordiazepoxide (Librium) 50-100 mg PO/IV q6h for 3 days.
Delirium tremens:
-Chlordiazepoxide (Librium) 100 mg slow IV push or PO, repeat q4-6h prn
agitation or tremor for 24h; max 500 mg/d. Then give 50-100 mg PO q6h
prn agitation or tremor OR
-Diazepam (Valium) 5 mg slow IV push, repeat q6h until calm, then 5-10 mg
PO q4-6h.
-Magnesium sulfate 1-8 gm in 100 mL D5W IV over 2h qd.
Seizures:
-Thiamine 100 mg IV push AND
-Dextrose water 50%, 50 mg IV push.
-Lorazepam (Ativan) 0.1 mg/kg IV at 2 mg/min; may repeat x 1 if seizures
continue.
Wernicke-Korsakoff Syndrome:
-Thiamine 100 mg IV stat, then 100 mg IV qd.
10. Symptomatic Medications:
-Multivitamin 1 amp IV, then 1 tab PO qd.
-Folate 1 mg PO qd.
