Alcohol abuse/withdrawal

Alcohol abuse/withdrawal:

  • Begin Delirium Tremens protocol (CIWA)
    1. Place patient on the CIWA protocol for alcohol withdrawal and monitor closely for symptoms.
    2. Order “Initiate Alcohol Withdrawal (CIWA) Protocol.”
  • Order toxicology: Alcohol plasma level, UDS (urine drug screen) acetaminophen level, salicylate level.
  • Concern for Wernicke encephalopathy: Give patient a banana bag at 125ml/hr. Also give IV fluids NS + 20mEq of KCl.
  • Supplemental Thiamine and Folate.
  • Keep on fall and aspiration precautions.
  • Patient will need the following vaccines: 1) pneumococcal (pneumovax) and 2) Hep B.Delirium Tremens (alcoholic withdrawal precautions): Note scoring system (CIWA) (chart). Ask nurse the patient’s score overnight and what medications were given according to each score at each time to assess management and improvement of withdrawal over time.
    • http://www.mdcalc.com/ciwa-ar-for-alcohol-withdrawal/

CIWA

 

 

 

 

 

 

 

 

 

Example orders in CIWA protocol:

  • Oxazepam (Serax):
    1. Scores 5-7: 15mg (1 cap) PO q4hr PRN
    2. Scores 8-10: 30mg (2 caps) PO q4hr PRN
    3. Scores +10: 45mg (3 caps) PO q2hr PRN
  • Lorazepam (Ativan):
    1. Scores 5-7: 0.5mg (0.25ml) IV (if unable to take PO) q4hr PRN
    2. Scores +7: 1mg (0.5ml) IV q4hr PRN
    3. Scores +10: 2mg (1ml) IV q2hr PRN (not to be used for delirium)
  • Diazepam (Valium):
    1. DTs/Seizures: 5-10mg IV q5min PRN (max dose: 40mg total)
    2. Hallucinations: 5mg (1ml) IV demand PRN (may repeat X 1 in 30 minutes if continued hallucinations)
  • Clonidine (Catapres):
    1. Blood pressure: (systolic +160)/(diastolic +100): 0.1mg (1 tab) PO q1hr PRN
      1. May repeat up to 3X
  • Percocet 5mg/325mg (oxycodone/acetaminophen): [max adult dose: 4g/day total of acetaminophen]
    1. PRN moderate pain (3-6): 1 tab PO q4hrs PRN moderate pain
    2. PRN severe pain (7-10): 2 tabs PO q4hrs PRN severe pain
  • Morphine 2-4mg IV q4hrs PRN
    1. “severe pain” (pain scale: 7-10)
  • Dilaudid

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