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Czynniki ryzyka majaczenia alkoholowego u osób leczonych stacjonarnie w Polsce z powodu uzależnienia od alkoholu. ALCOHOLISM AND DRUG ADDICTION 2016. [DOI: 10.1016/j.alkona.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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152
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Puscas M, Hasoon M, Eechevarria C, Cooper T, Tamura L, Chebbo A, W. Carlson R. Severe alcohol withdrawal syndrome: Evolution of care and impact of adjunctive therapy on course and complications of 171 intensive care unit patients. J Addict Dis 2016; 35:218-225. [DOI: 10.1080/10550887.2016.1164431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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153
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Abstract
Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder. The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.
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Affiliation(s)
- Jason P Connor
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Discipline of Psychiatry, The University of Queensland, Brisbane, QLD, Australia
| | - Paul S Haber
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Addictions Department, King's College London, London, UK.
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154
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Schmidt KJ, Doshi MR, Holzhausen JM, Natavio A, Cadiz M, Winegardner JE. Treatment of Severe Alcohol Withdrawal. Ann Pharmacother 2016; 50:389-401. [PMID: 26861990 DOI: 10.1177/1060028016629161] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Approximately 50% of patients with alcohol dependence experience alcohol withdrawal. Severe alcohol withdrawal is characterized by seizures and/or delirium tremens, often refractory to standard doses of benzodiazepines, and requires aggressive treatment. This review aims to summarize the literature pertaining to the pharmacotherapy of severe alcohol withdrawal. DATA SOURCES PubMed (January 1960 to October 2015) was searched using the search termsalcohol withdrawal, delirium tremens, intensive care, andrefractory Supplemental references were generated through review of identified literature citations. STUDY SELECTION AND DATA EXTRACTION Available English language articles assessing pharmacotherapy options for adult patients with severe alcohol withdrawal were included. DATA SYNTHESIS A PubMed search yielded 739 articles for evaluation, of which 27 were included. The number of randomized controlled trials was limited, so many of these are retrospective analyses and case reports. Benzodiazepines remain the treatment of choice, with diazepam having the most favorable pharmacokinetic profile. Protocolized escalation of benzodiazepines as an alternative to a symptom-triggered approach may decrease the need for mechanical ventilation and intensive care unit (ICU) length of stay. Propofol is appropriate for patients refractory to benzodiazepines; however, the roles of phenobarbital, dexmedetomidine, and ketamine remain unclear. CONCLUSIONS Severe alcohol withdrawal is not clearly defined, and limited data regarding management are available. Protocolized administration of benzodiazepines, in combination with phenobarbital, may reduce the need for mechanical ventilation and lead to shorter ICU stays. Propofol is a viable alternative for patients refractory to benzodiazepines; however, the role of other agents remains unclear. Randomized, prospective studies are needed to clearly define effective treatment strategies.
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Affiliation(s)
- Kyle J Schmidt
- Spectrum Health Butterworth Hospital, Grand Rapids, MI, USA
| | - Mitesh R Doshi
- St John Hospital and Medical Center, Grosse Pointe, MI, USA
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156
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Mo Y, Thomas MC, Karras GE. Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials. J Crit Care 2015; 32:101-7. [PMID: 26795441 DOI: 10.1016/j.jcrc.2015.11.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/30/2015] [Accepted: 11/19/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE To perform a systematic review of the clinical trials concerning the use of barbiturates for the treatment of acute alcohol withdrawal syndrome (AWS). MATERIALS AND METHODS A literature search of MEDLINE, EMBASE, and the Cochrane Library, together with a manual citation review was conducted. We selected English-language clinical trials (controlled and observational studies) evaluating the efficacy and safety of barbiturates compared with benzodiazepine (BZD) therapy for the treatment of AWS in the acute care setting. Data extracted from the included trials were duration of delirium, number of seizures, length of intensive care unit and hospital stay, cumulated doses of barbiturates and BZDs, and respiratory or cardiac complications. RESULTS Seven studies consisting of 4 prospective controlled and 3 retrospective trials were identified. Results from all the included studies suggest that barbiturates alone or in combination with BZDs are at least as effective as BZDs in the treatment of AWS. Furthermore, barbiturates appear to have acceptable tolerability and safety profiles, which were similar to those of BZDs in patients with AWS. CONCLUSIONS Although the evidence is limited, based on our findings, adding phenobarbital to a BZD-based regimen is a reasonable option, particularly in patients with BZD-refractory AWS.
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Affiliation(s)
- Yoonsun Mo
- Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119; Mercy Medical Center, 271 Carew Street, Springfield, MA 01104.
| | - Michael C Thomas
- Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119.
| | - George E Karras
- Mercy Medical Center, 271 Carew Street, Springfield, MA 01104.
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157
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New AM, Nelson S, Leung JG. Psychiatric Emergencies in the Intensive Care Unit. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Andrea M. New
- Andrea M. New is Critical Care Pharmacy Resident, Hospital Pharmacy Services, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 . Sarah Nelson is Clinical Pharmacist, Critical Care Specialist, Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Jonathan G. Leung is Clinical Pharmacist, Psychiatric Specialist, Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota
| | - Sarah Nelson
- Andrea M. New is Critical Care Pharmacy Resident, Hospital Pharmacy Services, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 . Sarah Nelson is Clinical Pharmacist, Critical Care Specialist, Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Jonathan G. Leung is Clinical Pharmacist, Psychiatric Specialist, Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota
| | - Jonathan G. Leung
- Andrea M. New is Critical Care Pharmacy Resident, Hospital Pharmacy Services, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 . Sarah Nelson is Clinical Pharmacist, Critical Care Specialist, Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Jonathan G. Leung is Clinical Pharmacist, Psychiatric Specialist, Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota
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158
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Chan CT, Liao WW, Huang W. Morphine for Intravenous Patient-Controlled Analgesia May Inhibit Delirium Tremens: A Case Report and Literature Review. Medicine (Baltimore) 2015; 94:e1829. [PMID: 26512587 PMCID: PMC4985401 DOI: 10.1097/md.0000000000001829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Alcoholism is common among trauma patients and often lacks the appropriate monitoring. Alcohol withdrawal syndrome (AWS), including delirium tremens (DT), can be associated with significant postoperative morbidity and mortality. However, appropriate acute pain management may protect against delirium; the administration of intravenous patient-controlled analgesia (IV - PCA) may not only alleviate pain, but also reduce the incidence of post-operative delirium. IV-PCA is widely used today; however, little attention has been paid to its influence on the development of AWS or DT post-surgery. Here we present a case in which the administration of IV-PCA may have delayed the onset of DT that interfered with postoperative care and the initiation of psychiatric consultation. The literature was reviewed to determine the potential mechanisms behind the effects of IV-PCA on the onset of AWS or DT.IV-PCA may delay the onset of DT. It is imperative to take into consideration trauma patients' psychiatric history including answers to questions on alcoholism, so that when an IV-PCA is administered and then discontinued, adequate interventions to prevent further morbidity associated with AWS and DT can be initiated in sufficient time.
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Affiliation(s)
- Chia-Ta Chan
- From the Department of Psychiatry, Shin-Kong Hospital, Taipei, Taiwan (C-TC, WH); Department of Anesthesiology, Shin-Kong Hospital, Taipei, Taiwan (W-WL); and College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan (W-WL)
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159
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Abstract
OBJECTIVE To review available evidence evaluating dexmedetomidine in alcohol withdrawal syndrome (AWS) while identifying gaps in evidence for its use in this setting. DATA SOURCES A MEDLINE search (1966-August 2015) to identify English-language articles evaluating the efficacy and safety of dexmedetomidine in alcohol withdrawal. Key words included alcohol, withdrawal, delirium tremens, and dexmedetomidine. Additional references were identified from a review of literature citations. STUDY SELECTION AND DATA EXTRACTION All English-language observational studies, retrospective reviews, and clinical trials were included. Case reports and case series describing the use of dexmedetomidine in 10 or fewer patients were excluded. DATA SYNTHESIS One randomized, controlled trial, 1 prospective observational study, and 6 retrospective reviews were identified. The only randomized, controlled trial identified showed that the addition of dexmedetomidine decreases benzodiazepine requirements more than placebo in the first 24 hours after initiation compared with the 24 hours prior to initiation (-56.8 mg vs -8 mg; P = 0.037). Overall, dexmedetomidine appears to lower benzodiazepine requirements in patients with AWS and decreases the sympathomimetic response seen in these patients. There was no convincing evidence that dexmedetomidine improves clinical endpoints in patients with AWS, such as need for mechanical ventilation or intensive care unit or hospital length of stay. CONCLUSIONS Dexmedetomidine reduces hypertension and tachycardia in AWS and also reduces benzodiazepine requirements; however, the impact of these findings on important clinical endpoints is yet to be determined. Dexmedetomidine may be useful as adjunctive therapy; however, it cannot be recommended as a single agent in the management of AWS.
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Affiliation(s)
- Dustin D Linn
- Manchester University College of Pharmacy, Fort Wayne, IN, USA Parkview Regional Medical Center, Fort Wayne, IN, USA
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160
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Kim DW, Kim HK, Bae EK, Park SH, Kim KK. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Am J Emerg Med 2015; 33:701-4. [PMID: 25745798 DOI: 10.1016/j.ajem.2015.02.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/19/2015] [Accepted: 02/17/2015] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures. METHODS Patients who visited the emergency department with acute seizures were included in the study when alcohol withdrawal was the only or the strongest precipitating factor for seizures. All patients were carefully observed for at least 48 hours in the intensive care unit after the initial assessment to closely monitor vital signs and development of DT. Clinical and laboratory findings were analyzed for predicting the development of DT. RESULTS Of the 97 patients (82 males; mean age, 48.6 ± 13.3 years) with alcohol withdrawal seizures, 34 (35.1%) developed DT. Low platelet count, high blood level of homocysteine, and low blood level of pyridoxine were associated with the subsequent development of DT. Low platelet count and high blood level of homocysteine were independent risk factors with high diagnostic sensitivity and specificity for the development of DT. CONCLUSIONS The study indicated that some easily determined parameters are potential clinical predictors for the development of DT in patients with alcohol withdrawal seizures. These findings would be helpful in clinical identification and management patients at high risk for DT.
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Affiliation(s)
- Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
| | - Hyun Kyung Kim
- Department of Neurology, National Medical Center, Seoul, Korea.
| | - Eun-Kee Bae
- Department of Neurology, Inha University Hospital, Incheon, Korea.
| | - So-Hee Park
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
| | - Kwang Ki Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea.
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162
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Muncie HL. Care of the Alcoholic Patient. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_66-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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