@MelBreggs reminds us not to document stigmatizing language in our notes:
✅risky/unhealthy use vs alcohol use disorder
❌alcohol abuse or dependence
#midwesthospmed
✅risky/unhealthy use vs alcohol use disorder
❌alcohol abuse or dependence
#midwesthospmed
-Uncomplicated withdrawal does not require treatment
-Complicated (seizures, hallucinosis, DTs) does require treatment and can be screened for using PAWSS
-PAWSS = 10 question survey, positive if 4 or higher
-specificity 99.5%, sensitivity 93%
-Complicated (seizures, hallucinosis, DTs) does require treatment and can be screened for using PAWSS
-PAWSS = 10 question survey, positive if 4 or higher
-specificity 99.5%, sensitivity 93%
-Symptom-triggered treatment > fixed schedule
-Monitoring is not perfect but AWSS better than CIWA
-Look for other complications of alcohol use disorder
-Don’t forget to check Mg (low levels make withdrawal worse) and give thiamine!
-Monitoring is not perfect but AWSS better than CIWA
-Look for other complications of alcohol use disorder
-Don’t forget to check Mg (low levels make withdrawal worse) and give thiamine!
-Once a patient has complicated withdrawal, they’re more likely to develop it again due to kindling effect.
-Gold standard for treatment remains benzos (long-acting better than short-acting, except hepatic impairment or elderly)
-Gold standard for treatment remains benzos (long-acting better than short-acting, except hepatic impairment or elderly)
Non-benzos:
-phenobarb - long half life, no hepatic dysfunction
-gabapentin - ok in hepatic impairment, dosing unclear
-carbamazepine - very effective but bad side effects
-VPA - also serious side effects
-alpha 2 adrenergic - act on norepi, can ⬇️ BP
-phenobarb - long half life, no hepatic dysfunction
-gabapentin - ok in hepatic impairment, dosing unclear
-carbamazepine - very effective but bad side effects
-VPA - also serious side effects
-alpha 2 adrenergic - act on norepi, can ⬇️ BP
