Withdrawal Syndrome

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Nursing Care of Patients with Alcohol Withdrawal Syndrome

Sabrina D. Jarvis, DNP, ACNP-BC
Brigham Young University
Provo, Utah, USA

Kent D. Blad, DNP, ACNP-BC, FCCM
Brigham Young University
Provo, Utah, USA

Alcoholism is prevalent in up to 20% of inpatient adults,(1) presenting a significant challenge when providing nursing care for the critically ill patient who develops acute alcohol withdrawal syndrome (AWS). Many of these patients are already compromised by underlying medical conditions, so alcohol withdrawal symptoms often complicate the clinical picture. These symptoms, which can be seen as early as 6 to 12 hours after the patient’s last drink, can range from mild to severe, can be mistaken for other serious medical conditions – such as stroke, sepsis, hypoglycemia and hypoxia – and can increase the associated risk of morbidity and mortality.(2)

If left untreated, mortality rates from severe alcohol withdrawal and delirium tremens (DTs) have been shown to be as high as 20%.(3) If AWS is recognized early and improved treatment is instituted, mortality rates have been reduced to 1% to 5%.(3) Nurses and other care providers must be

References: 1. Thompson W, Lande RG, Kalapatapu RK.. Alcoholism. eMedicine - Medical Reference website. http://emedicine.medscape.com/article/285913-print. Updated June 28, 2010. Accessed September 22, 2010. 2. Burns M, Price J, Lekawa ME. Delirium tremens. eMedicine - Medical Reference website. http://emedicine.medscape.com/article/166032-print. Updated April 14, 2010. Accessed September 22, 2010. 3. McKeown NJ, West PL. Withdrawal syndromes. eMedicine - Medical Reference website. http://emedicine.medscape.com/article/819502-overview. Updated March 18, 2010. Accessed September 22, 2010. 4. Riddle E, Bush J, Tittle M, Dilkhush D. Alcohol withdrawal: development of a standing order set. Crit Care Nurse. 2010;30:38-47. 5. McKinley MG. Alcohol withdrawal syndrome overlooked and mismanaged? Crit Care Nurse. 2005;25:40-48. 6. Sullivan J, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84:1353-1357. 7. Hecksel K, Bostwick JM, Jaeger TM, Cha SS. Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital. Mayo Clin Proc. 2008;83:274-279. 8. Weinberg J, Magnotti L, Fischer PE, et al. Comparison of intravenous ethanol versus diazepam for alcohol withdrawal prophylaxis in the trauma ICU: results of a randomized trial. J Trauma. 2008;64:99-104. 9. Chopra S, Khan RA, Bourgeois JA, Hilty DM. Delusional disorder. eMedicine - Medical Reference website. http://emedicine.medscape.com/article/292991-overview. Updated November 3, 2009. Accessed September 22, 2010. 10. Rausch D, Bjorklund P. Decreasing the costs of constant observation. J Nurs Adm. 2010;40:75-81. 11. Mattingly B, Small A. Chemical restraint. eMedicine - Medical Reference website. http://emedicine.medscape.com/article/109717-overview. Updated May 18, 2010. Accessed September 22, 2010. 12. Brick W, Burgess R. Macrocytosis. eMedicine - Medical Reference website. http://emedicine.medscape.com/article/203858-overview. Updated August 29, 2009. Accessed September 22, 2010.