ETOH withdrawal in SICU

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cfdavid

cfdavid

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Do you guys see this alot in the SICU??

I know only about 5% of chronic alcoholics with develop the DT's, but is there a strong index of suspicion even if a Pt isn't exactly forthecoming regarding his/her use??



cf
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Last edited:
cfdavid said:
Do you guys see this alot in the SICU??

I know only about 5% of chronic alcoholics with develop the DT's, but is there a strong index of suspicion even if a Pt isn't exactly forthecoming regarding his/her use??
cf
Click to expand...

Yes you see it and it's fairly abvious from biologic, morphologic and clinical picture.
 
cfdavid said:
Do you guys see this alot in the SICU??

I know only about 5% of chronic alcoholics with develop the DT's, but is there a strong index of suspicion even if a Pt isn't exactly forthecoming regarding his/her use??

Frankly, I ask this because a friend's dad is scheduled for surgery today and he's been a pretty big drinker, and the nature of this procedure (a Whipple) is going to land him in the SICU. Not sure how honest he's been with his surgeon or anesthesiologist. To be fair, I'm not speculating he's been dishonest (I have no idea), but any input on this would be great.

cf
Click to expand...

Probably won't work in this case, but this question brought back a memory of Med school rotation at the VA. We were taught something easy to remember about DT therapy. Give 2 mg of Ativan every 2 hours for 2 days. Easy to remember and in the few times I did it, it worked well. Also the IV Thiamin and other stuff, IIRC.

Just a fond memory from the old days.:)
 
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we put our trauma ICU pts on etoh gtt if their admit BAC was high then titrate it down over the course 3-4 days with liberal use of ativan PRN. The full dose gtt isn't enough to get someone drunk supposedly but its enough to reduce the incidence of full blown DTs.
 
lazylikeapanda said:
we put our trauma ICU pts on etoh gtt if their admit BAC was high then titrate it down over the course 3-4 days with liberal use of ativan PRN. The full dose gtt isn't enough to get someone drunk supposedly but its enough to reduce the incidence of full blown DTs.
Click to expand...

Wow - and I thought the only clinical use for ethanol, was methanol poisoning!

Be fairly pointless here - most of the ones coming in with high blood alcohols are binge drinkers...and generally not at risk of withdrawal.
 
When I was in the SICU, we had a post-CABG pt who developed cardiac tamponade from inadequate hemostatis/suturing. We had to perform CPR until the CT surgeon re-opened his chest in the SICU before taking him back to the OR. We then kept him on the vent longer than otherwise because of all the blood product resuscitation. On POD #2 or 3 (I've slept since then) he went into DTs, so we just kept him intubated. Since he was already on a fentanyl/ Versed drip, we just cranked up the Versed. (It seems like at one point, he was on 20 mg/hr.) We titrated it down as he recovered from the DTs. It worked great. He ended up doing quite well, especially considering everything he'd gone through.
 
FWIW, there's good data for dex in EtOH withdrawal in that it decreases BZD requirements, which is generally associated with better outcomes. I use it quite a bit and have had good results.
 
cchoukal said:
FWIW, there's good data for dex in EtOH withdrawal in that it decreases BZD requirements, which is generally associated with better outcomes. I use it quite a bit and have had good results.
Click to expand...

dex stands for? dexamethasone?
 
So I remember a patient I saw on neurology rotation...would like to hear what you guys think.

Pt was POD#7 s/p some sort of surgery (don't have details), and neurology was consulted for confabulation / confusion. Pt had h/o EtOH abuse in the past but according to the family, pt had "recovered" from EtOH abuse and was only having a glass of wine at dinner with the husband prior to admission.

We figured it must be DT given her EtOH h/o and clinical symptoms (she was confabulating a lot). So we recommended Ativan, but over the course of couple of days, she got worse (worsening confusion and hallucination) so psych was consulted. And they thought that the pt actually had an adverse reaction to benzos and recommended dc Ativan, which primary team did.

And then pt got better almost right away! We saw her the day after discontinuation of Ativan and she was A&Ox3.

So...what do you guys think? Does this happen often? What would you have done?
 
DScully said:
So I remember a patient I saw on neurology rotation...would like to hear what you guys think.

Pt was POD#7 s/p some sort of surgery (don't have details), and neurology was consulted for confabulation / confusion. Pt had h/o EtOH abuse in the past but according to the family, pt had "recovered" from EtOH abuse and was only having a glass of wine at dinner with the husband prior to admission.

We figured it must be DT given her EtOH h/o and clinical symptoms (she was confabulating a lot). So we recommended Ativan, but over the course of couple of days, she got worse (worsening confusion and hallucination) so psych was consulted. And they thought that the pt actually had an adverse reaction to benzos and recommended dc Ativan, which primary team did.

And then pt got better almost right away! We saw her the day after discontinuation of Ativan and she was A&Ox3.

So...what do you guys think? Does this happen often? What would you have done?
Click to expand...


7 days is WAY too far out for EtOH w/d. Think 2 days.

Confabulation is a sign of alcoholism, not w/d. How old was she? What were her meds? Chances are her problem was iatrogenic, likely a mix of post-op cog dysfx/delirium/meds.
 
DScully said:
So I remember a patient I saw on neurology rotation...would like to hear what you guys think.

Pt was POD#7 s/p some sort of surgery (don't have details), and neurology was consulted for confabulation / confusion. Pt had h/o EtOH abuse in the past but according to the family, pt had "recovered" from EtOH abuse and was only having a glass of wine at dinner with the husband prior to admission.

We figured it must be DT given her EtOH h/o and clinical symptoms (she was confabulating a lot). So we recommended Ativan, but over the course of couple of days, she got worse (worsening confusion and hallucination) so psych was consulted. And they thought that the pt actually had an adverse reaction to benzos and recommended dc Ativan, which primary team did.

And then pt got better almost right away! We saw her the day after discontinuation of Ativan and she was A&Ox3.

So...what do you guys think? Does this happen often? What would you have done?
Click to expand...

With the exception of that caused by ETOH withdrawa, benzos tend to worsen most post-operative cognitive dysfunction and delirium in the long run. In the short term, they may sedate a patient enough to make them tolerable, but at the expense of making them more disoriented upon recovery from the sedation.
 
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