Alcohol Withdrawal in the YK Delta

Alcohol withdrawal is a frequently encountered condition in the delta. The clinical challenge is to relieve the suffering of the patient (and by proxy, their housemates) while not indulging in interventions which promote further alcohol abuse and/or misuse of health care resources.

Most alcohol withdrawal in the delta is secondary to relatively short-term binges of 3 to 14 days.

Treatment Principles and Pearls

• All patients complaining of alcohol withdrawal should have a breath alcohol level measured. This is truly the "fifth vital sign" in such patients. The presence of a measurable alcohol level does not rule-out withdrawal, but it does provide important information for management during this and/or future visits.

• Patients suffering alcohol withdrawal do not fall asleep while waiting to be seen. Alcohol withdrawal is a state of autonomic hyper-activity and hyper-alertness. Consequently, most withdrawing patients present with an inability to sleep. The patient who is drowsy or falling asleep is almost certainly intoxicated and pursuing some type of secondary gain (i.e. hangover prevention, a place to sleep, prescription medication abuse, etc.) or suffering from some other medical problem. The clinician should be alert to the co-existence of true medical problems which require treatment, but providing the desired secondary gain should be avoided.

• If the shaky, over-anxious patient is driving you or the staff crazy, then they are almost certainly doing the same to their housemates. The patient's access to a bed or couch to sleep on frequently depends upon adequate treatment of their withdrawal symptoms. If patient is so irritating that everyone kicks them out, they will almost certainly bounce back to the ED. This alone is a reason to treat alcohol withdrawal. Patients who can sit still, keep down oral intake, and sleep are MUCH less likely to bounce back.

Phenobarbital

IV/IM phenobarbital is the preferred outpatient treatment of alcohol withdrawal at our facility. See Phenobarbital for Alcohol Withdrawal for details.