Dexmedetomidine Infusion as Adjunctive Therapy to Benzodiazepines for Acute Alcohol Withdrawal

2008 ◽  
Vol 42 (11) ◽  
pp. 1703-1705 ◽  
Author(s):  
Jamil Darrouj ◽  
Nitin Puri ◽  
Erin Prince ◽  
Anthony Lomonaco ◽  
Antoinette Spevetz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Delirium Tremens ◽  
Poor Response ◽  
Altered Mental Status ◽  
Primary Treatment ◽  
Respiratory Drive ◽  
Medical Unit ◽  
Pubmed Database

Objective: To report a case of alcohol withdrawal and delirium tremens successfully treated with adjunctive dexmedetomidine. Case Summary: A 30–year-old man with a history of alcohol abuse was admitted to the general medical unit because of altered mental status and agitation. He was initially treated for alcohol withdrawal with benzodiazepines; his condition then deteriorated and he was transferred to the intensive care unit. Because of the patient's poor response to benzodiazepines (oxazepam and lorazepam, with midazolam the last one used), intravenous dexmedetomidine was started at an initial dose of 0.2 µg/kg/h and titrated to 0.7 µg/kg/h to the patient's comfort. Midazolam was subsequently tapered to discontinuation due to excessive sedation. In the intensive care unit, the patient's symptoms remained controlled with use of dexmedetomidine alone. He remained in the intensive care unit for 40 hours; dexmedetomidine was then tapered to discontinuation and the patient was transferred back to the general medical unit on oral oxazepam and thiamine, which had been started in the emergency department. He was discharged after 5 days. Discussion: A review of the PubMed database (1989-2007} failed to identify any other instances of dexmedetomidine having been used as the principal agent to treat alcohol withdrawal. The use of sedative to treat delirium tremens Is well documented, with benzodiazepines being the agents of choice. The clinical utility of benzodiazepines is limited by their stimulation of the γ-aminobutyric acid receptors, an effect not shared by dexmedetomidine, a central α2-receptor agonist that induces a state of cooperative sedation and does not suppress respiratory drive. Conclusions: In patients with delirium tremens, dexmedetomidine should be considered as an option for primary treatment. This case illustrates the need for further studies to investigate other potential uses for dexmedetomidine.

scholarly journals Alcohol withdrawal

2020 ◽  
Vol 8 (35) ◽  
pp. 55-60
Author(s):  
Ashish Sarangi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Data Extraction ◽  
Delirium Tremens ◽  
Vital Signs ◽  
Chronic Alcoholism ◽  
Clinical Encounter ◽  
Case Review ◽  
Keywords And Phrases

Objective: This case review discusses the current recommended protocol for the diagnosis and treatment of delirium tremens using a review of a patient managed both in an inpatient psychiatry unit and in an intensive care unit. This review and case study are intended to help guide patient care with co-morbid conditions confounding diagnosis and in facilities lacking sophisticated monitoring equipment. Data Sources: PubMed was searched using keywords and phrases, including delirium tremens, alcohol withdrawal, chronic alcoholism, CIWA, alcohol effect on CNS, treatment of delirium tremens, and treatment of alcohol withdrawal. Study Selection: The case discussed provided the basis for this report based on its complexity due to comorbid conditions and the initial subacute presentation. Data Extraction: Data were gathered from charting notes written concurrently with patient management. Vital signs and laboratory values were regularly measured, and healthcare faculty documented each clinical encounter with findings and updates to treatment. Results: Delirium tremens was identified before progression to seizures and severe autonomic instability. Appropriate treatment and transfer to an intensive care unit were secured once a significant index of suspicion was reached. Conclusions: Close and frequent patient evaluation despite the lack of continuous monitoring technology allowed detection of decompensation as it began insidiously. The gradual development of cognitive symptoms and the presence of abnormal laboratory results helped identify his deterioration. The current guidelines for the treatment of delirium tremens provide the basis for the management of this highly dangerous disorder. Key Words: Delirium tremens, alcohol withdrawal biomarkers, geriatric delirium

scholarly journals Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tessa L. Steel ◽  
Shewit P. Giovanni ◽  
Sarah C. Katsandres ◽  
Shawn M. Cohen ◽  
Kevin B. Stephenson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Alternative Measure ◽  
Icu Patients ◽  
Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

Safety of Phenobarbital Use for Alcohol Withdrawal Syndrome in the Medical Intensive Care Unit

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 225A
Author(s):  
Krystal Cleven ◽  
lauren healy ◽  
Mabel Wei ◽  
Seth Koenig ◽  
Paul Mayo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Medical Intensive Care Unit ◽  
Alcohol Withdrawal Syndrome ◽  
Medical Intensive Care

Alcohol intoxication

2018 ◽  
Author(s):  
Satish Keshav ◽  
Palak Trivedi
Keyword(s):  
Alcohol Abuse ◽  
Alcohol Withdrawal ◽  
Physical Dependence ◽  
Alcohol Intoxication ◽  
Delirium Tremens ◽  
Alcohol Withdrawal Syndrome ◽  
Altered Mental Status ◽  
Severe Form ◽  
Alcoholic Beverages ◽  
Broad Term

Alcohol intoxication occurs when the quantity of alcohol (ethanol) consumed exceeds one’s tolerance for the substance, with consequent impairment of the individual’s mental and physical functional status. Alcohol abuse is a broad term for general ill health (mental, social, and/or physical) resulting from the repetitive, compulsive, and uncontrolled consumption of alcoholic beverages. Manifestations of alcohol abuse include a failure to fulfil one’s responsibilities, resulting in loss of employment, personal relationships, or finances. Alcohol dependence is a condition which arises as a result of alcohol abuse and occurs when an individual continually uses alcohol despite significant areas of dysfunction, with evidence of physical dependence.Alcohol withdrawal syndrome is the set of symptoms and physical signs observed when an individual reduces or abruptly stops alcohol consumption after prolonged periods of excessive intake; it is largely due to the development of a ‘hyperexcitable’ central nervous system. Delirium tremens is the most severe form of alcohol withdrawal; it manifests as altered mental status, hallucinations, and sympathetic overdrive, which may progress to cardiovascular collapse if left untreated.

scholarly journals CLONIDINE IN THE TREATMENT OF ALCOHOL WITHDRAWAL IN THE INTENSIVE CARE UNIT

1992 ◽  
Vol 68 (1) ◽  
pp. 106-108 ◽  
Author(s):  
P. C. IP YAM ◽  
A. FORBES ◽  
W.J. KOX
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal
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