Article Data

  • Views 1611
  • Dowloads 134

Review

Open Access

Inpatient management of alcohol withdrawal: a practical approach 

  • SHIVEN B. CHABRIA1

1,Dept of Internal Medicine Yale University School of Medicine Waterbury Hospital

DOI: 10.22514/SV31.042008.3 Vol.3,Issue 1,April 2008 pp.24-29

Published: 01 April 2008

*Corresponding Author(s): SHIVEN B. CHABRIA E-mail: shivenchabria@yahoo.com

Abstract

Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will be severe enough to require pharmacologic intervention. The total cost to the United States economy from alcohol abuse was estimated to be $185 billion for 1998. This review attempts to put forth a practical and evidence based approach towards the inpatient management of alcohol withdrawal. Various agents and their pharmacology are described. Strength of evidence regards to efficacy and shorter inpatient stays is examined. 

Keywords

substance abuse, phar-macology, addiction, pathophysiol-ogy, critical care

Cite and Share

SHIVEN B. CHABRIA. Inpatient management of alcohol withdrawal: a practical approach . Signa Vitae. 2008. 3(1);24-29.

References

1. Harwood HJ. Updating estimates of the economic costs of alcohol abuse in the United States: estimates, update methods and data. Report prepared by The Lewin Group for the National Institute on Alcohol Abuse and Alcoholism, 2000.

2. O’Connor PG, Schottenfeld RS. Patients with alcohol problems. N Engl J Med 1998;338:592-602.

3. Isbell H, Fraser HF, Wikler A, Belleville RE, Eisenman AJ. An experimental study of the etiology of rum fits and delirium tremens. Q J Stud Alcohol 1955;16:1-33.

4. Turner RC, Lichstein PR, Peden JG Jr, Busher JT, Waivers LE. Alcohol withdrawal syndromes: A review of pathophysiology, clinical pre-sentation, and treatment. J Gen Intern Med 1989;4:432-44.

5. Hawley RJ, Major LF, Schulman EA, Linnoila M. Cerebrospinal fluid 3-methoxy-4-hydroxyphenylglycol and norepinephrine levels in alcohol withdrawal. Correlations with clinical signs. Arch Gen Psychiatry 1985;42:1056-62.

6. Mantere T, Tupala E, Hall H, Särkioja T, Räsänen P, Bergström K, et al, editors. Serotonin transporter distribution and density in the cerebral cortex of alcoholic and nonalcoholic comparison subjects: a whole-hemisphere autoradiography study. Am J Psychiatry 2002;159:599-602.

7. Victor M. The role of hypomagnesemia and respiratory alkalosis in the genesis of alcohol-withdrawal symptoms. Ann N Y Acad Sci 1973;215:235-48.

8. Carlson RW, Keske B, Cortez A. Alcohol withdrawal syndrome: alleviating symptoms, preventing progression. J Crit Illness 1998;13(5):311-7.

9. Saitz R, O’Malley SS. Pharmacotherapies for alcohol abuse. Withdrawal and treatment. Med Clin North Am 1997;81:881-907.

10. Mayo-Smith MF, Beecher LH, Fischer TL, Gorelick DA, Guillaume JL, Hill A, et al, editors. Management of alcohol withdrawal delirium: an evidence-based practice guideline. Arch Intern Med 2004;164:1405-12.

11. Kirkwood CK, Melton ST. Anxiety disorders. In: DiPiro JT, Talbert RL, Yee GC, et al, editors. Pharmacotherapy: a Pathophysiologic Approach. 5th ed. 2002;71:1289-310.

12. Daeppen JB, Gache P, Landry U, Sekera E, Schweizer V, Gloor S, et al, editors. Symptom-triggered vs fixed-schedule doses of benzodi-azepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med 2002;162:1117-21.

13. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). Br J Addict 1989;84:1353-7.

14. Bostwick JM, Lapid MI. False positives on the clinical institute withdrawal assessment for alcohol-revised: is this scale appropriate for use in the medically ill? Psychosomatics 2004;45:256-61.

15. Cagetti E, Liang J, Spigelman I, Olsen RW. Withdrawal from chronic intermittent ethanol treatment changes subunit composition, reduces syn-aptic function, and decreases behavioral responses to positive allosteric modulators of GABAA receptors. Mol Pharmacol 2003;63:53-64.

16. McCowan C, Marik P. Refractory delirium tremens treated with propofol: A case series. Crit Care Med 2000;28:1781-4.

17. Coomes TR, Smith SW. Successful use of propofol in refractory delirium tremens. Ann Emerg Med 1997;30:825-8.

18. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA 1997; 278:144-51.

19. Colombo G, Serra S, Brunetti G, Vacca G, Carai MA, Gessa GL. Suppression by baclofen of alcohol deprivation effect in Sardinian alcohol-preferring (sP) rats. Drug Alcohol Depend 2003;70:105-8.

20. Addolorato G, Caputo F, Capristo E, Janiri L, Bernardi M, Agabio R, et al, editors. Rapid suppression of alcohol withdrawal syndrome by baclofen. Am J Med 2002;112:226-9.

21. Stuppaeck CH, Pycha R, Miller C, Whitworth AB, Oberbauer H, Fleischhacker WW. Carbamazepine versus oxazepam in the treatment of alcohol withdrawal: a double-blind study. Alcohol 1992;27:153-8.

22. Malcolm R, Ballenger JC, Sturgis ET, Anton R. Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. Am J Psychiatry 1989;146:617-21.

23. Malcolm R, Myrick H, Roberts J, Wang W, Anton RF, Ballenger JC. The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial. J Gen Intern Med 2002;17:349-55.

24. Polycarpou A, Papanikolaou P, Ioannidis J, Contopoulos-Ioannidis D. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev 2005;(3):CD005064.

25. Gasior M, Witkin JM, Goldberg SR, Munzar P. Chlormethiazole potentiates the discriminative stimulus effects of methamphetamine in rats. Eur J Pharmacol 2004;494:183-9.

26. Morgan MY. The management of alcohol withdrawal using chlormethiazole. Alcohol 1995;30:771-4.

27. Schied HW, Kimmerle K, Braunschweiger M. A retrospective comparison of delirium tremens cases before and after the availability of chlormethiazole. Acta Psychiatr Scand Suppl 1986;329:157-61.

28. Shaw GK. Chlormethiazole in the management of alcohol withdrawal. Acta Psychiatr Scand Suppl 1986;329:162-6.

29. Heinemann F, Assion HJ. Hepatotoxic side-effect of clomethiazole. Pharmacopsychiatry 1996 ;29:196-7.

30. Nimmerrichter AA, Walter H, Gutierrez-Lobos KE, Lesch OM. Double-blind controlled trial of gamma-hydroxybutyrate and clomethiazole in the treatment of alcohol withdrawal. Alcohol 2002;37:67-73.

31. Myrick H, Brady KT, Malcolm R. Divalproex in the treatment of alcohol withdrawal. Am J Drug Alcohol Abuse 2000;26:155-60.

32. Myrick H, Malcolm R, Brady KT. Gabapentin treatment of alcohol withdrawal. Am J Psychiatry 1998;155:1632.

33. Voris J, Smith NL, Rao SM, Thorne DL, Flowers QJ. Gabapentin for the treatment of ethanol withdrawal. Subst Abus 2003;24:129-32.

34. Lieber CS. Medical disorders of alcoholism. N Engl J Med 1995;333:1058-65.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top