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Face Addiction
Published in Sandra Rasmussen, Developing Competencies for Recovery, 2023
Granted, hospital-based and residential programs have many benefits. Alcohol detoxification may require medical treatment in the case of delirium tremens, a life-threatening alcohol withdrawal syndrome that occurs with heavy or long-term drinking. Some drugs, such as benzodiazepines, must be tapered slowly. Longer treatment programs provide patients with extended time to address factors that contributed to addiction. Relapse prevention is a major goal of longer treatment.
Drug Withdrawal: Recognition and Treatment
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
The patient is disoriented and hallucinating upon admission. Such patients in full delirium tremens usually require i.v. administration of medications and are usually managed better with two agents in combination. If I can obtain an i.v. route, I administer 10 mg of diazepam immediately and repeat the dose each 10 to 30 min. I simultaneously administer 5 mg of haloperidol i.m. Usually the person is calmed by these two measures. Subsequent withdrawal is treated as in other, less severely ill patients. It is nearly impossible to keep an i.v. drip in such patients, and occasionally they are so combative that i.v. injections are impossible. Lorazepam in 2-mg increments can be given i.m. each 30 min until the desired sedation is obtained. Large inner-city detoxification centers frequently use phenobarbital for this purpose. They give an initial dose of 300 to 350 mg i.m. or i.v. and repeat half this dose in 90 min if needed.
Psychiatric Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Delirium refers to a restless, confused, and disoriented state associated with fear and hallucinations. Delirium tremens (DTs) refers to a marked autonomic hyperactivity occurring three to four days after withdrawal from alcohol. Intoxication is defined as a syndrome that follows the recent ingestion and the presence in the body of a substance identified by maladaptive behavior. Idiosyncratic alcohol intoxication is a syndrome of marked intoxication with subsequent amnesia for that period.
Impact of alcohol withdrawal training program on knowledge, attitude, and perception among healthcare providers in a hospital setting
Published in Journal of Substance Use, 2022
Padma Rani Kumar, Anne Yee, Benedict Francis
Globally, alcohol use contributed to 5.9% of mortality and up to 5.1% of disability-adjusted life years (Rosenberg et al., 2017). The prevalence of current alcohol binge-drinkers among the Malaysian population is fairly high at 11.8% (NHMS 2019). This finding reflected an increase from 2015, whereby only 8.4% of Malaysians were found to binge-drink alcohol (NHMS, 2015). The cutoff limit for safe consumption of alcohol for both women and men is set at 14 units or lesser per week, however, consumption is best spread over a duration of 3 days or more (Officers, 2016). When an individual’s alcohol use becomes heavier, compulsive, and there is a loss of control over the intake, harmful use may progress into an alcohol use disorder (Carvalho et al., 2019). Our study emphasizes on alcohol withdrawal, which is left untreated, has a 10% progression rate into delirium tremens (Rahman & Paul, 2019). Hence, assessment and management of alcohol withdrawal need imperative clinical attention (Pecoraro et al., 2012).
Person first and patient first: Tailoring language to individual patient needs
Published in Substance Abuse, 2019
Shortly after the panel discussion, my co-residents and I had the opportunity to speak with Mike (name changed), a patient with alcohol use disorder, as he served as a guest-in-recovery in one of our didactic ambulatory sessions. Mike had spent so much of the previous year in the hospital that most of my cohort of residents had cared for him before. Some of my co-residents had managed his delirium tremens in the intensive care unit (ICU); I had treated him for milder alcohol withdrawal on the general medicine wards. More recently, some of us had seen him in our addiction medicine clinic, which is embedded within our longitudinal primary care resident practice. Removed from the pressures of a busy workday, we sat in a circle with Mike and really heard his story.
Substance use disorders: diagnosis and management for hospitalists
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ahmed K. Pasha, Arnab Chowdhury, Sanah Sadiq, Jeremiah Fairbanks, Shirshendu Sinha
Often times, the initial encounter of an acutely intoxicated person is in the emergency department. The patient should be assessed for adequate airway, breathing and circulation, and intravenous fluids should be initiated. Concurrently a ‘banana bag’ (dextrose, thiamine, folic acid, multivitamin) should be administered. Once the patient is stabilized, he/she may be admitted to the hospital for further observation if appropriate. Alcohol withdrawal severity scale (PAWSS) predicts the severity of withdrawal and helps in determining the level of care needed by the patient [9]. As an inpatient, patients are usually managed symptomatically with intravenous fluids, anti-emetics as needed, thiamine, folic acid, multivitamins and use of restraints in agitated patients. Monitoring of the effects of alcohol on non-neurological organ systems is also an important task of the hospitalist. Attention should be paid to liver function tests (LFTs), electrolytes and blood glucose levels if patient is not eating well. Effort should be made to avoid letting a severely intoxicated patient to leave the hospital until their mentation improves as the patient is at high risk of self-harm in their altered state and physicians could be held responsible in case of harm to others or self- [8]. It is reasonable to put patients on a 72-h hold until the improvement of mentation. Intoxicated patients who have AUD have a high potential to undergo acute alcohol withdrawal as their blood alcohol level (BAL) decreases in the setting of abstinence. Severe alcohol withdrawal in the form of delirium tremens (DTs) could be life threatening and requires emergent treatment [10].