Académique Documents
Professionnel Documents
Culture Documents
1 of 8
INVESTIGATIONS:
FBC
CRP (infection and sepsis can be missed in these patients, have a low
threshold for cultures as well)
LFT
Coagulation Profile
2 of 8
IMMEDIATE TREATMENT:
Monitor BMs regularly (at least 4 hourly) during the first 24-48 hours
and 2 hourly if drowsy or confused.
Patient Monitoring
Please note that the detox regimen may require modification according to the
patient response. NICE recommends that the dose required to treat Alcohol
withdrawal might exceed the one recommended by the BNF in order to achieve
response. Therefore, patients should be assessed regularly and dose adjusted
(increased/reduced) or regimen changed according to response
3 of 8
Subsequent Management
Grantham
Beaconfield Centre, Beacon Lane,
Grantham, NG31 9DF
Tel: 01476 591233
Email: grantham.dart@nhs.net
Lincoln
Carholme Court, Long Leys Road,
Lincoln LN1 1FS
Tel: 01522 597979
Email: lincoln.dart@nhs.net
4 of 8
Give thiamine (IV pabrinex 2 pairs of amp I&II) for prevention and
treatment of Wernickes.
Look for and correct any electrolyte abnormalities.
Monitor closely for hypoglycaemia and correct only under
pabrinex cover, to avoid precipitating Wernickes encephalopathy.
Manage withdrawal symptoms according to the severity of alcohol withdrawal
and continue to monitor patients using CIWAA-R withdrawal scale
MILD WITHDRAWAL
CIWAA-R Score <10
Reassure and refer to
local alcohol support
services, if available in
the community
If agitated and
treatment required
give 5-10 mg of
chlordiazepoxide 6-8
hourly for the 1st 24-48
hrs.
Monitor 4 hourly
MODERATE
WITHDRAWAL
CIWAA-R Score 10-19
SEVERE
WITHDRAWAL
CIWAA-R Score >20
Start chlordiazepoxide
at a dose of 20-30 mg 6
hourly and 10-20 mg to
be given as required to
achieve
symptom
control
Start chlordiazepoxide
at a dose of 40 mg 6
hourly and 10-20 mg
to be given as required
to achieve symptom
control
For patients who develop delirium tremens, oral lorazepam should be offered and
if patient declined the oral medications, parenteral lorazepam, haloperidol or
olanzapine can be considered.
Recommended BNF max dose of chlordiazepoxide is 250mg/24hrs, but higher
doses may be required.
Benzodiazepines should be sufficient to control Alcohol withdrawal seizures
(phenytoin should NEVER be used to treat Alcohol withdrawal seizures).
All patients nutritional status should be assessed by a dietician and offered
dietary supplements if indicated.
Upon
discharge
following
clear information should
be provided
Management
of Acute Alcohol
Withdrawal successful
ULHT/G/214/546detox,
A
5 of 8
CESC
Approved March
2014their
Review
Date
March 2016support service providers.
to
patients
about
local
alcohol
Drink Type
Volume
Strength
Units
568 ml
4.0%
2.3
Beer
5.0%
1.6
A pint of cider
568 ml
4.5%
2.6
Glass of wine
175 ml
13%
2.3
Glass of champagne
125 ml
12%
1.5
Spirit (single)
25 ml
40 %
A pint of beer
This is a guidance to calculate alcohol intake for individual patients, you can
also use the alcohol calculator tool available online on the following link:
http://www.nhs.uk/Tools/Pages/Alcohol-unit-calculator.aspx
6 of 8
Document Control
The Trust must be able to demonstrate that the documents are researched
and based on best practice and that all guidelines are audited and reviewed
therefore:
The following sections must be completed, with a clear statement of who will
be responsible for the dissemination, implementation and review of the
document?
Version History Log
This table should detail the version history for this document. It should detail
the key changes when a version is amended.
Version
1.
Date Implemented
February 2014
2.
Implementation strategy
To be promoted through clinical governance meeting and the monthly audit
meetings.
Consultants to inform their junior doctors
Ward managers to inform nursing staff that the guideline is in use
Authors
Abdulfatah Masaud, Specialty doctor in Gastroenterology, department of
gastroenterology, Pilgrim Hospital.
Imad Wazir, CMT1 Doctor, Department of Gastroenterology, Pilgrim Hospital.
References:
1- Alcohol-use DISORDERs, THE NICE GUIDELINE ON DIAGNOSIS,
ASSESSMENT AND MANAGEMENT OFHARMFUL DRINKING AND
ALCOHOL DEPENDENCE, National Clinical Practice Guideline 115.
Published by: The British Psychological Society and The Royal College
of Psychiatrists 2011.
7 of 8
2- Sullivan, J.T.; Sykora, K.; Schneiderman, J.; Naranjo, C.A.; and Sellers,
E.M. Assessment of alcohol withdrawal: The revised Clinical Institute
Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of
Addiction 84:1353-1357, 1989.
3- www.bnf.org
Signature Sheet
Clinical Document Title: Management of Acute Alcohol Withdrawal
Date of Development: March 2014
NAME
SIGNATURE
Print Name
Signed
Abdulfatah Masaud
Anita Raj
Richard Armstrong
Michael Perry
Signed
Sathish Babu
Author(s) confirm that they have collected all the signatures, as listed
above, and posted to Clinical Governance Development Unit, Corridor F,
Grantham Hospital.
YES / NO
Jim Campbell
8 of 8