Alcohol withdrawal Talk – Renee Jennings and AOD registrar
(with thanks to Dr Gemma Ridley for summary)
Specific to alcohol :
***When was the last drink****
How much they drink
Previous seizures
Blood alcohol level on arrival
Tolerance
Diazepam loading dose – as seizures can happen 6-12 hours after last drink.
Diazepam used as long acting
CIWA – MDCalc https://www.mdcalc.com/ciwa-ar-alcohol-withdrawal for assessment of alcohol withdrawal
Assessment of how much alcohol and whether needs an admission / need a diazepam loading dose :
Delirium Tremens – due to increases glutamate activity.
Usually doesn’t occur until days 2 and can continue to day 7.
- which is why you need to know last drink (ie if they present confused and hallucinating and have drank 2 days ago v 2 hours ago)
- No string evidence re antipsychotic mono therapy
- Treatment is benzodiazepines
Wernicke‘s encephalopathy – confusion, ataxia and nystagmus. Untreated = wernicke- korskoff syndrome– severe memory loss and confabulation
Prophylaxis– if have poor diet
- Thiamine. 500mg IV TDS (3days) or Thiamine IM OD 200mg (3days)
Treatment – two or more of: confusion, ataxia, nystagmus, poor diet
- Thiamine. 500mg IV TDS (3 days)
Maintenance – 100mg TDS PO Thiamine after above
Sometimes recommend oxazepam in the elderly and in cirrhosis instead of diazepam.(15mg oxazepam is approx 5mg diazepam)
How to talk about booze!?
Normalise, explain why you’re asking
Ensure best care – ie if you withdraw we can give you meds
Non judgemental
Brief interventions
Aims: sharing knowledge, increasing awareness of risks and problems associated with substance use. Assist patients in reducing or giving up their substance use.
Best used for patients in precontemplation and contemplation
“Tell me about your substance use” – Helps to gauge where they are in the change cycle.
FRAMES approach to delivering brief interventions.
FEEDBACK – on risks, negative consequences “do you know about the risks of daily alcohol use”
RESPONSIBILITY – individual has responsibility of choices, gives them a sense of control. “up to you what you do with this information”
ADVICE – inform about harm associated with substance use. Give advice on modifying substance use – ie stop reduce etc. Benefits of stopping.
MENU OF OPTIONS – patient led decision making. Refer to AOD
EMPATHY – non judgmental, “I know it will be difficult”. Avoid confrontation, blaming or criticism.
SELF EFFICACY – express optimism that the individual can modify behaviour. Provide support and encouragement.
Recognise they sought help today / friends and family supportive acknowledge that.
Menu of options:
Individual v group bases
Residential v home/community based
Public v Private
Useful contacts
DIRECTLINE
1800 888 236 – first point of contact. Cards in the ED
Contacts in the ED
FH – Renee Jennings
SH – Tom Jones
Fax referral to addiction services – 8345 6027