Monitoring

Inpatients 

Monitor all patients who have been admitted every hour until they are stable; in particular:

  • Use the CIWA-Ar score to monitor response to drug treatment​[2][45]​​[1]

  • Check blood glucose

  • Observe vital signs using a validated scoring system recommended by your local protocols, such as the National Early Warning Score 2 (NEWS2).[150]

Outpatients 

Refer any patient who is dependent on alcohol and wants to stop drinking to specialist alcohol services so they can be assessed for community-based alcohol withdrawal.[32]

  • Do not advise the patient to suddenly stop or reduce their alcohol intake while waiting for outpatient services as this could precipitate severe withdrawal symptoms.[1]

  • If possible, the patient should gradually reduce their intake over several weeks/months. It is common practice to advise the patient to decrease their level of drinking by not more than 25% every 2 weeks.

Do not prescribe medication to patients being managed in the community unless they have adequate assessment and support as successful withdrawal is unlikely and there are considerable associated clinical risks.[10]

A community-based alcohol withdrawal programme will vary in intensity according to the severity of the patient’s alcohol dependence, available social support and the presence of comorbidities.[32]

  • This may include regular meetings with programme staff, psychological support, access to self-help groups and family and carer support and involvement.[32]

  • Avoid giving people in the community large quantities of medication to take home to prevent overdose or diversion. Prescribe for installment dispensing, with no more than 2 days' medication supplied at any time.[32]

  • Monitor the patient every other day during assisted withdrawal. A family member or carer should preferably oversee the administration of medication. Adjust the dose if severe withdrawal symptoms or over-sedation occur.[32]

  • Do not offer clomethiazole for community-based assisted withdrawal because of the risk of overdose and misuse.[32]

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