Hey, it’s been a big week on the psychiatry consultation service and the medical students are working hard. Senior medical student Jaclyn Keller, who plans to enter residency in Dermatology, delivered a top-notch Clinical Problems in Consultation Psychiatry (CPCP) presentation yesterday, which was on Halloween. You’ll notice the next-to-the-last slide is a picture of a her little dog wishing everyone a happy Halloween. I don’t think the dog’s name is ToTo–but it sort of looks like it.
I encounter alcohol use disorders and their complications nearly every day. Like many of the other consult requests I get, my colleagues in medicine and surgery are interested in providing the highest quality medical care and prevent problems like alcohol withdrawal delirium and withdrawal seizures. If at all possible, you really want to prevent this fire rather than struggle to put it out. However, it can be difficult to get a clear history of alcohol use disorder for a host of reasons, not the least of which is the stigma with which the problem is viewed. Management often feels like walking a tightrope.
Experienced doctors, (and this doesn’t just mean psychiatric consultants) will have different approaches to managing alcohol withdrawal. Many of us believe that previous guidelines which recommended beta-blockers and clonidine might not prevent alcohol withdrawal delirium; rather, they may mask it’s development. The mainstay of treatment…benzodiazepines.
Another impression many of us have is that if a patient has a witnessed alcohol withdrawal seizure as the first sign of withdrawal, it may be safer to stick with a scheduled benzodiazepine taper rather than a symptom-triggered withdrawal protocol.
You’ll probably still find some hospitals where beverage alcohol is used in a misguided effort to treat or prevent alcohol withdrawal. A number of years ago a couple of our pharmacists and I wrote an article for our hospital’s pharmacy and therapeutics newsletter, treatment etoh withdrawal amos et al 2009 which included a recommendation to avoid this approach.
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