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Alcohol dependence and Safe
Withdrawal
In-patient detox in Dr Grays
Liaison and Emergency Psychiatry
Moray
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Moray
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Moray
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Statistics
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Alcohol sales data suggests that consumption has
increased by 11% since 1994.
In 2010, 23% more alcohol was sold in Scotland than in
England & Wales, the widest gap to date.
Impact of this excessive consumption is estimated to cost
Scots £3.6 billion each year, equivalent to £900 for each &
every adult in Scotland.
Alcohol cost Scotland’s health service £405 million (2008
figures).
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High % of patients admitted to hospitals
may experience some symptoms of
withdrawal from alcohol.
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Detox can be inconsistent and dependence is
not always recognised until there is an episode
of violence where the patient at a later time is
identified as suffering from psychosis due
delirium tremens.
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Cost to the NHS in Scotland is rising
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Moray
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How do you know if someone
is withdrawing from alcohol?
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Not always this obvious!
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Mild Withdrawal Symptoms – 4 Hourly
observations for 24 hours
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Slight tachycardia (80-99)
Tremor
Sweating
Anxiety
Restlessness
Insomnia
Poor concentration and memory
Low mood.
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Moderate to severe withdrawal –
hourly observations
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Rapid pulse (100+)
Systolic hypertension
Constant tremor of arms & body
Profuse sweating
Panic
Autonomic hyperactivity
Formed & vivid hallucinations
Disorientation to time; place & person
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Symptoms of Wernicke’s Encephalopathy
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acute confusion
altered consciousness
memory disturbance
Ataxia
Opthalmoplegia
Nystagmus
unexplained hypotension with hypothermia.
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Delirium Tremons
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Definition of Delirium Tremons
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An acute & sometimes fatal episode of
delirium caused by withdrawal or
absence from alcohol.
Characterized by hallucinations &
delusions; anxiety; confusion; sweating &
trembling
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Moray
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“Prevention is better than cure”
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The aim is to provide a safe and consistent
approach to hospital in-patients withdrawing
from the affects of alcohol.
Ultimately the reduction or prevention of inpatients developing the delirium tremens will
improve patient and staff safety.
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Two heads or specialities are better
than one!
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Approved regime for detox in Dr Grays Hospital
has not been agreed.
Previously Psychiatry and the General Hospital
were two separate entities and neither were
keen to accept responsibility for the alcohol
dependent patient.
Patients dependent on alcohol come from all
walks of life, these include nurses, doctors,
bankers, politicians etc there are no exceptions.
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Moray
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Withdrawal from alcohol can result in
socially unacceptable or dangerous
behaviours.
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Advantages of prompt and effective detox are;
1. Reduction in length of admission.
2. Reduction of costs for care of each patient.
3. Reduction in the episodes of violent or
aggressive incidents.
4. Reduction in episodes of serious illness or
death.
5. Improved staff knowledge.
6. Happier staff and patients.
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Treatment of Withdrawals
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Detoxification regime
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Medication used in Moray is
Chlordiazepoxide at regular intervals (46hrs) dose depending on severity of
dependence maximum dose 210mgs
daily. If this is not sufficient Consultant
advice is recommended.
Diazepam is also used in alcohol
withdrawal
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Considerations in Prescribing
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Level of alcohol dependence
Age i.e. elderly patients at increased risk of side effects
from benzodiazepines therefore start low & go slow
Metabolism of Chlordiazepoxide is impaired by liver
failure. Can be used cautiously in small doses. For
severe liver failure Lorazepam may by used as Lorazepam
metabolism is not impaired in liver disease.
Chlordiazepoxide 25mg=Lorazepam 1mg=Diazepam10mg
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Moray
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Vitamins
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Thiamine 100mgs three times daily
Pabrinex is an option for the
malnourished patient or patients who are
unable to accept an oral diet. Pabrinex
must be given prior to IV glucose
therapy.
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Reducing regime
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Calculate the total amount of Chlordizepoxide
taken in the last 24 hours, deduct one dose,total
remaining is divided by four or five depending
on frequency of drug administration times.
Continue in this way until detox has been
completed. Maximum dose including PRN should
not exceed previous days total.
Learn to recognise the signs and symptoms of
withdrawal
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Alcohol Withdrawal
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Prompt treatment in A&E can minimise
complications
Obtain an accurate drinking history
Prompt use of Chlordiazepoxide
Remember vitamins – Thiamine, Pabrinex
?Alcohol Liaison Nurse
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Moray
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Emergency Sedation Policy
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Emergency sedation as per policy may be
required in the event that a patient withdraws
from alcohol in an unsafe or uncontrolled way.
Uncontrolled or unrecognised withdrawal may
result in episodes of aggression or violence.
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Discussion
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