Alcohol Withdrawal Protocols
Alcohol Withdrawal Protocols focuses on safe, evidence-based management of autonomic hyperactivity, seizures, and delirium risk during acute cessation. This page turns guidance into bedside steps: triage by severity and comorbidity; choose symptom-triggered vs fixed-dose regimens; and coordinate nursing checks, thiamine, fluids, and sleep strategies. If you’re comparing events like an alcohol withdrawal conference, you’ll find practical pathways for ED/inpatient initiation with booked follow-ups, escalation rules, and discharge criteria that prevent rebound or readmission. Because protocols must dovetail with longer-term care, we link to Detox and Withdrawal Management for transitions into maintenance medications, psychotherapy, and community supports.
Implementation lives in details: standardised assessments, order sets, and warm handoffs. Teams align CIWA-Ar or alternative tools with monitoring frequency, manage seizure risk with benzodiazepines or phenobarbital where indicated, and protect nutrition and Wernicke prevention with parenteral thiamine before glucose. Comorbidity matters—hepatic disease, sleep apnea, pregnancy, older age—so dosing and setting selection adapt to physiology and social supports. Post-acute plans address cravings, insomnia, and mood symptoms while initiating acamprosate, naltrexone, or disulfiram as appropriate. Clear education, family involvement, and safety nets (naloxone for polysubstance risk, rapid access slots) reduce relapse and harm while improving confidence for patients and staff.
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Triage and level of care
- Stratify by history of seizures, delirium, and comorbidity to select ED observation, inpatient, or ICU.
- Use structured tools (e.g., CIWA-Ar) and vitals to guide admission and monitoring intensity.
Medication strategy
- Choose symptom-triggered benzodiazepines for most; consider phenobarbital or adjuncts in refractory cases.
- Account for hepatic function, respiratory risk, and drug interactions when setting doses.
Nutritional and neuroprotection
- Give parenteral thiamine before glucose to prevent Wernicke encephalopathy.
- Replace electrolytes and support sleep with non-sedating options where possible.
Discharge and linkage
- Set clear criteria, relapse-prevention plans, and booked follow-ups.
- Transition immediately to maintenance treatment and psychosocial support.
Implementation and Care Pathways
ED/inpatient order sets
Protocolise assessments, dosing ranges, escalation steps, and safety checks to reduce variation and errors.
Bridge to maintenance
Initiate acamprosate or naltrexone when stable; coordinate counselling and peer support before discharge.
Pain and sedative co-use
Screen for benzodiazepines, opioids, and gabapentinoids; prevent respiratory compromise and misuse.
Sleep and anxiety management
Prefer behavioural strategies and non-addictive adjuncts; reassess once acute withdrawal resolves.
Family education and risk planning
Teach warning signs, seizure precautions, and when to seek urgent help; provide written plans.
Equity and access
Address transport, cost, and literacy barriers; arrange outreach calls in the first week post-discharge.
Quality and audit
Track severe events, LOS, readmissions, and patient-reported outcomes; update protocols accordingly.
Special populations
Adapt for pregnancy, older adults, and liver disease with adjusted doses and closer monitoring.
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