AKA: DTs, Severe alcohol withdrawal
WHAT IS IT: “Excessive nervous system excitability” (4). Withdrawal symptoms that generally start a couple of days after the last ETOH drink (in chronic alcohol abusers). It is considered medical emergency
SYMPTOMS: Auditory & visual hallucinations, nausea/vomiting, diarrhea, pins & needles, agitation, shaking, confusion, anxiety, palpitations, chest pain (MedlinePlus)
PHYSICAL ASSESSMENT: Fever, tachycardia, high blood pressure, pale skin color, diaphoretic, tremors, tachypnea
RISK FACTORS: Stopping chronic alcohol use abruptly
EMERGENT MEDICATIONS USED FOR TX: Lorazepam, Valium (benzodiazepines help prevent seizures)
OTHER MEDS THAT MAY BE USED: Folic acid, magnesium, multivitamin, thiamine injection, Famotidine (alcoholic gastritis), Zofran
POTENTIAL DRIPS/FLUIDS: Banana bag, IV fluids, magnesium
ABNORMAL LABS COMMONLY SEEN: Click here to see the post listing commonly seen labs
TESTS: EKG, ETOH level, Mag, phosphorus, CBC, CMP, GABA, Urine drug screen, ABG’s
COMPLICATIONS: Seizures, myocardial infarction, liver complications, gastritis, Wernicke encephalopathy, Wernicke Korsakoff Syndrome, severe electrolyte disturbances, injury from seizures
TREATMENT GOAL: Prevent seizures, control agitation, control nausea & vomiting, control blood pressure, heart rate, prevent injury, and other treat other uncomfortable symptoms from withdrawal.
NURSING ORDERS/PROCEDURES: Seizure, fall, elopement precautions. CIWA, Psyche consult as indicated for depression/SI/HI, (3)
DIFFERENTIAL DX: Opioid overdose, illicit drug use overdose, encephalopathy, stroke, amphetamine toxicity Click here for a more comprehensive list on emedicine.medscape.com)
REFERENCES:
- MedlinePlus medical Encyclopedia
- Emedicine.medscape.com
- AAFP.org
- http://emedicine.medscape.com/article/166032-overview
