see also: [[Alcohol-related disease]] see: [Hayes' Alcohol Withdrawal Syndrome](x-devonthink-item://491A8049-25BC-4631-A8D7-CF62F7B31668) - [Emergency Department Management of Patients With Alcohol Intoxication / AWS (Scott Taylor)](bookends://sonnysoftware.com/ref/DL/270852) - [Best evidence topic report. Oral or intravenous thiamine in the emergency department.](bookends://sonnysoftware.com/ref/DL/268459) - [AWS RMH guideline (bear)](bear://x-callback-url/open-note?id=D570616B-B576-4797-B8EE-77E6144060DB) - [Victoria AWS guidelines](x-devonthink-item://D76CCD69-2CE0-48E5-8089-409E47F53451?page=42) - [Dunn - Alcohol withdrawal](x-devonthink-item://518D5F3A-AD02-4123-A5E9-3020BEA95CD6) ![[Pasted image 20240915142014.png]] | | Autonomic hyperactivity | GI features | cog and perceptual changes | | ------ | -------------------------------------------------------------------- | ------------------------------------------------------------------ | -------------------------------------------------------------------------------------------------- | | mild | - sweating<br>- tachycardia<br>- tremor<br>- HTN<br>- fever < 37 deg | - anorexia<br>- nausea<br>- vomiting<br>- dyspepsia<br>- diarrhoea | - poor concentration<br>- anxiety<br>- psychomotor agitation<br>- disturbed sleep and vivid dreams | | severe | - dehydration and electrolyte disturbance | | - [[Seizures]]<br>- hallucinations or perceptual disturbances<br>- delirium | **patients at ↑ risk of EtOH withdrawal:** - \> 10 std drinks/day without regular EtOH-free days - BAL ≥ 0.2% without signs of intoxication - prior hx of alcohol withdrawal - admission with EtOH-related illness and currently drinking - inter-current condition causing tissue hypoxia (pneumonia, shock), pain, or other stress, or recent anaesthetic will put a pt at ↑ risk ## medications (general considerations) - IV thiamine 300mg TDS for 9 doses, then step down to 100mg BD for 5 weeks - AWS Prn diazepam 10-20mg for score >12 - can do oxazepam 15-30mg q2H max 210 - Daily multivitamin ## Alcohol Withdrawal Scale see [AWS score](x-devonthink-item://5B5EFD87-9814-4E46-863A-5AB75D899684?page=2) 1. perspiration (0-4 points) 2. Tremor (0-3 points) 3. Anxiety (0-4 points) 4. Agitation (0-4 points) 5. Nausea / Vomiting (0-3) 6. Hallucinations (0-4) 7. Orientation (0-4) 8. Headaches (0-3) 9. Facial Flushing (0-2) 10. Seizures (0 OR 10) > note: may be different now. Dunn has a different way of scoring | domain | score | | --------------------- | ----------------------------------------------------------------------------------------------------- | | nausea / vomiting | - 1 no nausea<br>- 7 constant nausea | | tactile disturbance | - 0 none<br>- 1 mild itching<br>- 4 moderately severe hallucinations<br>- 7 continuous hallucinations | | tremor | - 0 no tremor<br>- 1 not visible<br>- 7 severe | | paroxysmal sweating | - 0 none<br>- 1 barely perceptible<br>- 4 beads of sweat<br>- 7 drenching sweats | | auditory disturbances | - 0 none<br>- 1 mild sensitivity<br>- 4 moderate<br>- 7 continuous hallucinations | | visual disturances | - none<br>- 1 mild sensitivity<br>- 4 moderate<br>- 7 continuous | | anxiety | - 0 none<br>- 1 mild<br>- 4 mod<br>- pacing, thrashing | | agitation | - 0 none<br>- 1 mild<br>- 4 mod<br>- 7 severe | | headache | - 0 none<br>- 1 mild<br>- 7 severe | | orientation | - 0-4 | | Score | management | | ----- | ---------------------------------------------------------------------------- | | ≤5 | monitor AWS Q4H | | 6-8 | next AWS in 2 H | | 9-11 | next AWS in 1 H | | ≥ 12 | - 20 mg diazepam PRN<br>- assess again in 1H<br>- notify if ≥ 3 doses needed |