3,155
Views
15
CrossRef citations to date
0
Altmetric
Review

Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives

, , & ORCID Icon
Pages 53-65 | Published online: 19 Mar 2020

References

  • White AM, Slater ME, Ng G, Hingson R, Breslow R. Trends in alcohol-related emergency Department visits in the United States: results from the Nationwide Emergency Department Sample, 2006 to 2014. Alcohol Clin Exp Res. 2018;42(2):352–359. doi:10.1111/acer.2018.42.issue-2
  • Qian S, Irani M, Brighton R, et al. Investigating the management of alcohol‐related presentations in an Australian teaching hospital. Drug Alcohol Rev. 2019. doi:10.1111/dar.12906
  • Klein LR, Cole JB, Driver BE, Battista C, Jelinek R, Martel ML. Unsuspected critical illness among emergency Department patients presenting for acute alcohol intoxication. Ann Emerg Med. 2018;71(3):279–288. doi:10.1016/j.annemergmed.2017.07.021
  • Long D, Long B, Koyfman A. The emergency medicine management of severe alcohol withdrawal. Am J Emerg Med. 2017;35:1005–1011. doi:10.1016/j.ajem.2017.02.002
  • Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use and Health (NSDUH). Tables 2.28A, 2.30A, 2.31A. Available from: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetTabs2-28to2-31pe2018.pdf. Accessed September 16, 2019.
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
  • Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 alcohol use disorder. JAMA Psychiatry. 2015;72(8):757. doi:10.1001/jamapsychiatry.2015.0584
  • Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use and Health (NSDUH). Table 5.2B - Substance use disorder in past year among persons aged 12 or older, by detailed age category: percentages, 2017 and 2018; 2019. Available from: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetTabs5-2pe2018.pdf. Accessed September 16, 2019.
  • World Health Organization. Global status report on alcohol and health. World Health Organization; 2011. [Updated 2011]. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf. Accessed October 16, 2019.
  • Centers for Disease Control and Prevention. Alcohol Related Disease Impact (ARDI) application; 2013. Available from: www.cdc.gov/ARDI. Accessed September 13, 2019.
  • Mullins PM, Mazer-Amirshahi M, Pines JM. Alcohol-Related Visits to US Emergency Departments, 2001–2011. 2016.
  • Snyder H. Literature review as a research methodology: an overview and guidelines. J Bus Res. 2019;104:333–339. doi:10.1016/j.jbusres.2019.07.039
  • Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: meta-narrative reviews. BMC Med. 2013;11. doi:10.1186/1741-7015-1111-1120
  • Burns P, Rohrich R, Chung K. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg. 2011;128(1):305–310. doi:10.1097/PRS.0b013e318219c171
  • Simpson S, Wilson M, Nordstrom K. Psychiatric emergencies for clinicians: emergency department management of alcohol withdrawal. J Emerg Med. 2016;51(3):269–273. doi:10.1016/j.jemermed.2016.03.027
  • Cohen B. Theory and Practice of Psychiatry. New York, NY: Oxford University Press; 2003.
  • Mirijello A, D’Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353–365. doi:10.1007/s40265-015-0358-1
  • Kosten T, O’Connor P. Management of drug and alcohol withdrawal. N Engl J Med. 2003;348:1786–1795. doi:10.1056/NEJMra020617
  • Hall W, Zador D. The alcohol withdrawal syndrome. Lancet. 1997;349:1897–1900. doi:10.1016/S0140-6736(97)04572-8
  • Wood E, Albarouni L, Tkachuk S, et al. Will this hospitalized patient develop severe alcohol withdrawal syndrome? JAMA. 2018;320(8):825–833. doi:10.1001/jama.2018.10574
  • Maldonado J, Sher Y, Das S, et al. Prospective Validation of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in medically ill inpatients: a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol Alcoholism. 2015;50(5):509–518. doi:10.1093/alcalc/agv043
  • Maldonado J. Novel algorithms for the prophylaxis and management of alcohol withdrawal syndromes – beyond benzodiazepines. Crit Care Clin. 2017;33(3):559–599. doi:10.1016/j.ccc.2017.03.012
  • Stephane M, Arnaout B, Yoon G. Alcohol withdrawal hallucinations in the general population, an epidemiological study. Psychiatry Res. 2018;262:129–134. doi:10.1016/j.psychres.2018.02.021
  • Rathlev N, Ulrich A, Delanty N, D’Onofrio G. Alcohol-related seizures. J Emerg Med. 2006;31(2):157–165. doi:10.1016/j.jemermed.2005.09.012
  • Eyer F, Schuster T, Felgenhauer N, et al. Risk assessment of moderate to severe alcohol withdrawal—predictors for seizures and delirium tremens in the course of withdrawal. Alcohol Alcoholism. 2011;46(4):427–433. doi:10.1093/alcalc/agr053
  • Schmidt K, Doshi M, Holzhausen J, Natavio A, Cadiz M, Winegardner J. Treatment of severe alcohol withdrawal. Ann Pharmacother. 2016;50(5):389–401. doi:10.1177/1060028016629161
  • Schuckit M. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014;371(22):2109–2113. doi:10.1056/NEJMra1407298
  • Sullivan J, Sykora K, Schneiderman J, Naranjo C, Sellers E. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353–1357. doi:10.1111/add.1989.84.issue-11
  • Cassidy E, O’Sullivan I, Bradshaw P, Islam T, Onovo C. Symptom-triggered benzodiazepine therapy for alcohol withdrawal syndrome in the emergency department: a comparison with the standard fixed dose benzodiazepine regimen. Emerg Med J. 2012;29:802–804. doi:10.1136/emermed-2011-200509
  • Gray S, Borgundvaag B, Sirvastava A, Randall I, Kahan M. Feasibility and reliability of the SHOT: A short scale for measuring pretreatment severity of alcohol withdrawal in the emergency department. Acad Emerg Med. 2010;17(10):1048–1054. doi:10.1111/acem.2010.17.issue-10
  • Higgins J, Bugajski A, Church D, et al. A psychometric analysis of CIWA-Ar in acutely ill and injured hospitalized patients. J Trauma Nurs. 2019;26(1):41–49. doi:10.1097/JTN.0000000000000414
  • Eloma A, Tucciarone J, Hayes E, Bronson B. Evaluation of the appropriate use of a CIWA-Ar alcohol withdrawal protocol in the general hospital setting. Am J Drug Alcohol Abuse. 2018;44(4):418–425. doi:10.1080/00952990.2017.1362418
  • Allison MG, McCurdy MT. Alcoholic metabolic emergencies. Emerg Med Clin North Am. 2014;32(2):293–301. doi:10.1016/j.emc.2013.12.002
  • Flannery A, Adkins D, Cook A. Unpeeling the evidence for the banana bag: evidence-based recommendations for the management of alcohol-associated vitamin and electrolyte deficiencies in the ICU. Crit Care Med. 2016;44(8):1545–1552. doi:10.1097/CCM.0000000000001659
  • Sharp C, Wilson M, Nordstrom K. Psychiatric emergencies for clinicians: emergency department management of Wernicke-Korsakoff syndrome. J Emerg Med. 2016;51(4):401–404. doi:10.1016/j.jemermed.2016.05.044
  • Day E, Bentham P, Callaghan R, Kuruvilla T, George S. Thiamine for prevention and treatment of Wernicke‐Korsakoff Syndrome in people who abuse alcohol. Cochrane Database Syst Rev. 2013;7.
  • Stehman C, Mycyk M. A rational approach to the treatment of alcohol withdrawal in the ED. Am J Emerg Med. 2013;31:734–742. doi:10.1016/j.ajem.2012.12.029
  • Stahl S. Stahl’s Essential Psychopharmacology. Vol. 4th. New York: Cambridge University Press; 2013.
  • Mayo-Smith M. Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline. JAMA. 1997;278(2):144–151. doi:10.1001/jama.1997.03550020076042
  • Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2010;3.
  • Daeppen J, Gache P, Landry U, et al. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002;162(10):1117–1121. doi:10.1001/archinte.162.10.1117
  • Weaver M, Hoffman H, Johnson R, Mauck K. Alcohol withdrawal pharmacotherapy for inpatients with medical comorbidity. J Addict Dis. 2006;25(2):17–24. doi:10.1300/J069v25n02_03
  • Holleck J, Merchant N, Gunderson C. Symptom-triggered therapy for alcohol withdrawal syndrome: a systematic review and meta-analysis of randomized controlled trials. J Gen Intern Med. 2019;34(6):1018–1024. doi:10.1007/s11606-019-04899-7
  • Bachhuber M, Hennessy S, Cunningham C, Starrels J. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996–2013. Am J Public Health. 2016;106(4):686–688. doi:10.2105/AJPH.2016.303061
  • Longo L, Johnson B. Addiction: part 1. Benzodiazepines - side effects, abuse risk and alternatives. Am Fam Physician. 2000;61(7):2121–2128.
  • Grover S, Ghosh A. Delirium tremens: assessment and management. J Clin Exp Hepatol. 2018;8(4):460–470. doi:10.1016/j.jceh.2018.04.012
  • Griffin C, Kaye A, Bueno F, Kaye A. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013;13(2):214–223.
  • Nisavic M, Nejad S, Isenberg B, et al. Use of phenobarbital in alcohol withdrawal management – a retrospective comparison study of phenobarbital and benzodiazepines for acute alcohol withdrawal management in general medical patients. Psychosomatics. 2019;60(5):458–467. doi:10.1016/j.psym.2019.02.002
  • Löscher W. How theories evolved concerning the mechanism of action of barbiturates. MRES. 2012;53(Suppl 8):12–25.
  • Hendey G, Dery R, Barnes R, Snowden B, Mentler P. A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal. Am J Emerg Med. 2011;29(4):382–385. doi:10.1016/j.ajem.2009.10.010
  • Nelson A, Kehoe J, Sankoff J, Mintzer D, Taub J, Kaucher K. Benzodiazepines vs barbiturates for alcohol withdrawal: analysis of 3 different treatment protocols. Am J Emerg Med. 2019;37(4):733–736. doi:10.1016/j.ajem.2019.01.002
  • Rosenson J, Clements C, Simon B, et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J Emerg Med. 2013;44(3):592–598. doi:10.1016/j.jemermed.2012.07.056
  • Sullivan S, Dewey B, Jarrell D, Vadiei N, Patanwala A. Comparison of phenobarbital-adjunct versus benzodiazepine-only approach for alcohol withdrawal syndrome in the ED. Am J Emerg Med. 2019;37:1313–1316. doi:10.1016/j.ajem.2018.10.007
  • Ibarra F. Single dose phenobarbital in addition to symptom-triggered lorazepam in alcohol withdrawal. Am J Emerg Med. 2019. doi:10.1016/j.ajem.2019.01.053
  • Mo Y, Thomas M, Karras G. Barbiturates for the treatment of alcohol withdrawal syndrome: a systematic review of clinical trials. J Crit Care. 2016;32:101–107. doi:10.1016/j.jcrc.2015.11.022
  • Levine A, Carrasquillo L, Mueller J, Nounou M, Naut E, Ibrahim D. High-dose gabapentin for the treatment of severe alcohol withdrawal syndrome: a retrospective cohort analysis. Pharmacotherapy. 2019;39(9):881–888. doi:10.1002/phar.v39.9
  • Leung J, Hall-Flavin D, Nelson S, Schmidt K, Schak K. Role of gabapentin in the management of alcohol withdrawal and dependence. Ann Pharmacother. 2015;49(8):897–906. doi:10.1177/1060028015585849
  • Leung J, Rakocevic D, Allen N, et al. Use of a gabapentin protocol for the management of alcohol withdrawal: a preliminary experience expanding form the consult-liaison psychiatry service. Psychosomatics. 2018;59(5):496–505. doi:10.1016/j.psym.2018.03.002
  • Mason B, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA Intern Med. 2014;174(1):70–77. doi:10.1001/jamainternmed.2013.11950
  • Kranzler H, Feinn R, Morris P, Hartwell E. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547–1555. doi:10.1111/add.v114.9
  • Reoux J, Saxon A, Malte C, Baer J, Sloan K. Divalproex sodium in alcohol withdrawal: a randomized double-blind placebo-controlled clinical trial. Alcohol Clin Exp Res. 2001;25(9):1324–1329.
  • Barrons R, Roberts N. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. J Clin Pharm Ther. 2010;35(2):153–167. doi:10.1111/j.1365-2710.2009.01098.x
  • Chance J. Emergency department treatment of alcohol withdrawal seizures with phenytoin. Ann Emerg Med. 1991;20(5):520–522. doi:10.1016/S0196-0644(05)81606-3
  • Minozzi S, Amato L, Vecchi S, Davoli M. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2010;3.
  • Benedict N, Wong A, Cassidy E, et al. Predictors of resistant alcohol withdrawal (RAW): a retrospective case-control study. Drug Alcohol Depend. 2018;192:303–308. doi:10.1016/j.drugalcdep.2018.08.017
  • Sarff M, Gold J. Alcohol withdrawal syndromes in the intensive care unit. Crit Care Med. 2010;38(9 Suppl):S494–S501. doi:10.1097/CCM.0b013e3181ec5412
  • Ratsma JE, Stelt OVD, Gunning W. Neurochemical markers of alcoholism vulnerability in humans. Alcohol Alcoholism. 2002;37(6):522–533. doi:10.1093/alcalc/37.6.522
  • Hack J, Hoffmann R, Nelson L. Resistant alcohol withdrawal: does unexpectedly large sedative requirement identify these patients early? J Med Toxicol. 2006;2(2):55–60. doi:10.1007/BF03161171
  • Sohraby R, Attridge R, Hughes D. Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation. Ann Pharmacother. 2014;48(4):456–461. doi:10.1177/1060028013515846
  • Lorentzen K, Lauritsen A, Bendtsen A. Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens. Dan Med J. 2014;61(5):1–5.
  • Brotherton A, Hamilton E, Kloss H, Hammond D. Propofol for treatment of refractory alcohol withdrawal syndrome: a review of the literature. Pharmacotherapy. 2016;36(4):433–442. doi:10.1002/phar.2016.36.issue-4
  • Coomes T, Smith S. Successful use of propofol in refractory delirium tremens. Ann Emerg Med. 1997;30(6):825–828. doi:10.1016/S0196-0644(97)70059-3
  • Wong A, Benedict N, Lohr B, Pizon A, Kane-Gill S. Management of benzodiazepine-resistant alcohol withdrawal across a healthcare system: benzodiazepine dose-escalation with or without propofol. Drug Alcohol Depend. 2015;154:296–299. doi:10.1016/j.drugalcdep.2015.07.005
  • Dixit D, Endicott J, Burry L, et al. Management of acute alcohol withdrawal syndrome in critically ill patients. Pharmacotherapy. 2016;36(7):797–822. doi:10.1002/phar.1770
  • Shah P, McDowell M, Ebisu R, Hanif T, Toerne T. Adjunctive use of ketamine for benzodiazepine-resistant severe alcohol withdrawal: a retrospective evaluation. J Med Toxicol. 2018;14(3):229–236. doi:10.1007/s13181-018-0662-8
  • Wong A, Benedict N, Armahizer M, Kane-Gill S. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015;49(1):14–19. doi:10.1177/1060028014555859
  • Pizon A, Lynch M, Benedict N, et al. Adjunct ketamine use in the management of severe ethanol withdrawal. Crit Care Med. 2018;46(8):E768–E771. doi:10.1097/CCM.0000000000003204
  • Muzyk A, Fowler J, Norwood D, Chilipko A. Role of α2-agonists in the treatment of acute alcohol withdrawal. Ann Pharmacother. 2011;45(5):649–657. doi:10.1345/aph.1P575
  • Wong A, Smithburger P, Kane-Gill S. Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome. Am J Drug Alcohol Abuse. 2015;41(5):382–391. doi:10.3109/00952990.2015.1058390
  • Mueller S, Preslaski C, Kiser T, et al. A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal. Crit Care Med. 2014;42(5):1131–1139. doi:10.1097/CCM.0000000000000141
  • Lyon J, Khan R, Gessert C, Larson P, Renier C. Treating alcohol withdrawal with oral baclofen: a randomized, double-blind, placebo-controlled trial. J Hosp Med. 2011;6(8):469–474. doi:10.1002/jhm.928
  • Cooney G, Heydtmann M, Smith I. Baclofen and the alcohol withdrawal syndrome - a short review. Front Psychiatry. 2019;9:1–5. doi:10.3389/fpsyt.2018.00773
  • Liu J, Wang L. Baclofen for alcohol withdrawal. Cochrane Database Syst Rev. 2017;8.
  • Barata I, Shandro J, Montgomery M, et al. Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review. West J Emerg Med. 2017;18(6):1143–1152. doi:10.5811/westjem.2017.7.34373
  • Schmidt CS, Schulte B, Seo HN, et al. Meta-Analysis on the Effectiveness of Alcohol Screening with Brief Interventions for Patients in Emergency Care Settings. 2015:n/a–n/a.
  • Mee-Lee D, Shulman G. The ASAM criteria and matching patients to treatment. In: Ries R, Fiellin D, Miller S, Saitz R, editors. The ASAM Principles of addiction Medicine. 5th ed. China: Wolters Kluwer Health; 2014.
  • Botswick J. Medication Table 6: benzodiazepines. In: Chavez B, editor. CPNP Psychiatric Pharmacotherapy Review Course. 2018–2019 ed. Lincoln, NE: College of Psychiatric and Neurologic Pharmacists; 2018.
  • Daeppen JB, Gache P, Landry U, et al. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002;162(10):1117–1121. doi:10.1001/archinte.162.10.1117
  • Sachdeva A, Chandra M, Deshpande SN. A comparative study of fixed tapering dose regimen versus symptom-triggered regimen of lorazepam for alcohol detoxification. Alcohol Alcohol. 2014;49(3):287–291. doi:10.1093/alcalc/agt181
  • Krishnamjurthy A; American Society of Addiction Medicine. Management of alcohol intoxication and withdrawal. In: Cavacuiti C editor, Principles of Addiction Medicine: The Essentials. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011:204–211.
  • Malcolm R, Ballenger JC, Sturgis ET, Anton R. Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. Am J Psychiatry. 1989;146(5):617–621.
  • Myrick H, Malcolm R, Randall PK, et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009;33(9):1582–1588. doi:10.1111/acer.2009.33.issue-9
  • Lyon JE, Khan RA, Gessert CE, Larson PM, Renier CM. Treating alcohol withdrawal with oral baclofen: a randomized, double-blind, placebo-controlled trial. J Hosp Med. 2011;6(8):469–474. doi:10.1002/jhm.928