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ETOH Intoxication

1. Tremulousness (6-12 hours after last drink)

  • Pt irritable, hypervigilant, agitated. coarse tremor of hands and tongue
  • Thiamine 100mg IV, MVI, Folate 1 mg IV/PO. Give thiamine before glucose
  • Mg replacement, watch for drop in phosphate
  • Valium 5-20 mg IV q20min until stops or Librium 25-100 mg po q6hrs. monitor closely for oversedation

2. Seizures

  • If no past h/o seizure, work up to r/o head trauma, meningitis, brain abscess, etc.
  • If past h/o EtOH seizure, treat as other seizures but loading with anticonvulsants not indicated

3. Delirium Tremens - autonomic instability with fluctuating mental status. 2-7 days after last drink, usually with visual hallucinations, perspiration, fever, tachycardia, hypertension. This is a medical emergency. mortality is approx. 5%

  • Valium 5-10 mg q4-6h or Librium 25-100 mg po at presentation, repeat as needed in 1 hr, then 25-100 mg q 4-6 hr x 24 hrs. Reduce the initial 24 hr dose by 25% over next 2-3 days in divided doses. monitor respirations
  • thiamine, folate, MVI iv/po
  • replete  Mg, K, Ca, PO4
  • rule out infection, pneumonia
  • admit to monitored setting

4. Start CIWA protocol for all suspected chronic alcoholics

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