PART 3 / CH 23
Alcohol Withdrawal Checklist
| Blood Pressure < 140/90 0 pt 140/90 – 158/98 1 160/100- 175/110 2 176/110 –199/110 3 > 200/110 4 | Tremors Inner shakes 0 Inner shakes & fine tremor 1 Tremor on holding objects 2 Visible tremors 3 Tremor preventing ambulation 4 |
|---|---|
| Anxiety Mild/able to sit 0 Mood swings, freq. purposeful activity 1 Easily agitated 2 Pacing/nightmares 3 Hallucination 4 | Mental Status Alert, Ox4 0 Forgets simple instructions 1 Occ. forgets locale 2 Confused/ Ox2 3 Confused/ Ox1 4 |
| Pulse 90 or less 0 91-100 1 101-120 2 121-139 3 140 and above 4 | Nausea/Vomiting Occ. nausea 0 Nausea, but eats small amounts 1 Vomits x1 q shift 2 Vomits x 2 q shift 3 Unable to eat due to neurological status 4 |
| Diaphoresis Occ. sweaty palms 0 Palms always wet 1 Areas of damp clothes 2 Beads of sweat seen 3 Clothing soaked 4 | Staging < 4 points Stage 0 4-7 points Stage I 8-14 points Stage II 15-21 points Stage III 22 + Stage IV |
source: Addiction Research Foundation Clinical Institute Withdrawal Assessment -Alcohol, revised (CIWA-Ar)
Alcohol Detoxification Protocol
A. In all patients
· Thiamine 100 mg IM x 1, then PO QD x 7 d
· MVI 1 PO QD, Folate 1 mg PO QD
· Check vital signs and staging q 4 hr x 24 hr
B. Proctor I protocol
day 1: Librium 50mg PO q2h PRN x24h; vitals q4h while awake.
day 2: give 75% of total day 1 dose, divided QID
day 3: give 50%, day 4 give 25%, day 5 D/C…
(use Serax 45mg PO q2h PRN x24h when liver disease is present)
C. Alternative protocol
· day 1: check vitals and staging (see chart) q4h;
PRN Stage I or greater (see chart), give either…
- Librium 25-50mg PO q 4-6 hr
- Valium 5-10mg PO q 4-6 hr
- Serax 15-45mg PO q 2-4 hr. (use if hepatic disease present)
· day 2: give 100% of total day 1 dose divided QID;
change vital signs and staging orders to q 6 hours, and monitor for PRN’s usage over the next 24 hrs.
- If none used, decrease benzodiazepine by 50% a day until d/c.
- If additional PRN’s needed, add the amount used to the scheduled amount, and give that amount in scheduled divided doses over the next 24 hr period.
D. Self-taper protocol (Diazepam front-loading)
· day 1: diazepam 5-10mg PO q20 minutes (less aggressive: 20mg PO q2h) until patient is sedated and no withdrawal signs are noted. Diazepam (and its active metabolite, nordiazepam) will self-taper over next 2-3d.
source: Gastfriend DR, Elman I, Solhkhah R (1998) Psychiatric Clinics of N America: Annual of Drug Therapy.