Monitoring

All patients need close monitoring for delirium, in line with local guidelines, electrolyte repletion and intravenous fluid infusion as indicated, as well as regular vital signs, fluid intake and output, and serum electrolytes.[5]

Admission to the intensive care unit for more intense monitoring is indicated in patients with hemodynamic instability, severe electrolyte abnormalities, cardiac disease, respiratory distress, potential severe infections, persistent hyperthermia, signs of gastrointestinal pathology, evidence of rhabdomyolysis, renal insufficiency, need for frequent or high doses of sedatives (including benzodiazepines and barbiturates) or endotracheal intubation, or with symptoms of withdrawal despite elevated serum ethanol concentration.[89]

Other patient groups who require intensive monitoring include:

  • Those who have an alcohol withdrawal seizure; reassess every 1-2 hours for 6-24 hours.[5] These patients should be monitored as inpatients for at least 36-48 hours after the seizure, to ensure there are no further seizures and alcohol withdrawal delirium does not develop.[88]

  • Patients who are agitated or delirious; should have continuous, one-to-one observation.[5] Patients with alcohol withdrawal delirium require close nursing observation and supportive care, which often necessitates admission to an intensive or critical care unit.[5]

  • Patients requiring pharmacotherapy, or with moderate to severe alcohol withdrawal syndrome (AWS); monitor closely and reassess every 1-4 hours, as clinically indicated.[5]

Gradual reduction in monitoring frequency can occur once the patient becomes medically stable. In patients with mild symptoms and low risk of severe or complicated AWS, monitoring can cease after 36 hours, as more severe withdrawal is very unlikely to subsequently develop.[5] Monitoring should be facilitated by a validated assessment scale, combined with review of psychologic and emotional status, vital signs, and for side effects of treatment such as sedation or respiratory depression. Patients with current or historic benzodiazepine or opioid use disorder may require closer monitoring.[5]

Following successful management of withdrawal symptoms, patients should be encouraged to attend counseling. This may be in the form of a support group, or provided by a healthcare professional at their family practice. Management of alcohol dependence is required to facilitate abstinence.[1][6]

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