2. PATIENT ASSESSMENT
•IS THIS PATIENT AT RISK FOR ACUTE ALCOHOL
WITHDRAWAL SYNDROME?
•CAGE TOOL
• SIMPLE, FAST, EASY, RELIABLE
• A SCORE OF 2-4 = AT RISK FOR ALCOHOL
WITHDRAWAL
• OBTAIN DETAILED ALCOHOL HISTORY

3. CLINICAL INSTITUTE OF WITHDRAWAL
ASSESSMENT OF ALCOHOL – CIWA-AR
• ASSIGNS A NUMERIC VALUE TO THE PATIENT’S LEVEL OF ALCOHOL
WITHDRAWAL ~ 0 TO 67
• BASED ON THE SEVERITY OF PHYSICAL AND PSYCHOLOGICAL SYMPTOMS
• ⬆ SCORE = ⬆ SEVERITY OF WITHDRAWAL
• DETERMINES FREQUENCY OF PATIENT ASSESSMENT
• ALLOWS CALCULATION OF SYMPTOM-TRIGGERED BENZODIAZEPINE DOSAGE
• NAUSEA/VOMITING
• TREMOR
• PAROXYSMAL SWEATS
• ANXIETY
• AGITATION
• TACTILE DISTURBANCES
• AUDITORY DISTURBANCES
• VISUAL DISTURBANCES
• HEADACHES/FULLNESS IN HEAD
• ORIENTATION/CLOUDING OF SENSORIUM

4. BENZODIAZEPENES
• SYMPTOM-TRIGGERED DOSAGE SIGNIFICANTLY
DECREASES BOTH THE DURATION OF TREATMENT
AND THE TOTAL BENZODIAZEPINE USAGE DURING
ACUTE ALCOHOL WITHDRAWAL (“BENZODIAZEPINES ARE THE
MAINSTAY,” 2014)
• BASED ON THE INDIVIDUAL PATIENT’S SCORE AND
WHETHER OR NOT IT IS IMPROVING
• REQUIRES OBJECTIVE WITHDRAWAL ASSESSMENT
SCALE

5. DELIRIUM TREMENS
• LIFE THREATENING FORM OF ALCOHOLWITHDRAWAL
• SYMPTOMS CAN INCLUDE HALLUCINATIONS, IRREGULAR
HEARTBEAT AND TONIC-CLONIC SEIZURES
• ADMINISTER HALOPERIDOL IN ORDER TO MANAGE SYMPTOMS
(NORTHWEST HOSPITAL, 2015)
• LOW PLATELET COUNT AND HIGH BLOOD LEVEL OF HOMOCYSTEINE
ARE PREDICTORS OF DELIRIUM TREMENS; VITAMINS B12, B6, AND
FOLIC ACID COULD PREVENT DELIRIUM TREMENS (KIM, KIM, BAE, PARK, &
KIM, 2015)

6. WARNICKE-KORSAKOFF SYNDROME
• WARNICKE’S ENCEPHALOPATHY CAN CAUSE ATAXIA, NYSTAGMUS, ALTERED MENTAL STATUS AND CAN
PROGRESS TO A COMA OR DEATH
• KORSAKOFF’S PSYCHOSIS CAUSES SEVERE BRAIN DAMAGE THAT CAN CAUSE HALLUCINATIONS, SEVERE
MEMORY LOSS AND THE INABILITY TO FORM NEWMEMORIES
• ALL PATIENTS WHO ARE EXPERIENCING ALCOHOL WITHDRAWAL SHOULD RECEIVE ORAL THIAMINE AND
THOSE AT HIGH RISK FOR WARNICKE’S ENCEPHALOPATHY SHOULD RECEIVE THIAMINE PARENTALLY FOR
THREE DAYS (“MANAGING ALCOHOL WITHDRAWAL,” 2012)

7. MANAGEMENT OF ACUTE ALCOHOL
WITHDRAWAL SYNDROME
• EARLY INTERVENTION – CAGE TOOL
• SYMPTOM-TRIGGERED DOSAGE OF BENZODIAZEPINES
• USE HALOPERIDOL TO MANAGE SYMPTOMS OF DELIRIUM
TREMENS
• ADMINISTER THIAMINE TO PREVENTWARNICKE-KORSAKOFF
SYNDROME

8. REFERENCES
Benzodiazepines are the mainstay of treatment for acute alcohol withdrawal syndrome. (2014). Drugs & Therapy
Perspectives, 30, 395-398. http://dx.doi.org/10.1007/s40267-014-0152-2
Kim, D. W., Kim, H. K., Bae, E.-K., Park, S.-H., & Kim, K. K. (2015). Clinical predictors for delirium tremens in
patients with alcohol withdrawal seizures. American Journal of Emergency Medicine, 33, 701-704.
http://dx.doi.org/10.1016/j.ajem.2015.02.030
Management of alcohol withdrawal. (2012). Retrieved May 10, 2016, from
http://www.who.int/mental_health/mhgap/evidence/alcohol/q2/en/
Northwest Hospital. (2015) Acute alcohol withdrawal symptom management (nursing). (Policy Number A-2).
Randallstown, MD.