Alcohol Withdrawal in the Inpatient Setting

Kylie Lucas, PharmD, BCPS; Glenn R. Grantner, PharmD, BCPS; Jonathan Street, PharmD


US Pharmacist. 2019;44(11):HS-8-HS12. 

In This Article

Supportive Care

Supportive care includes addressing nutritional deficits, treating dehydration, and preventing delirious patients from harming themselves or others. In patients with abnormal vital signs or underlying comorbidities, these factors should be monitored and stabilized as much as possible on presentation. Patients with a long history of AUD often present with malnutrition, which is attributable to poor dietary intake and malabsorption in the gastrointestinal (GI) tract. Chronic alcoholism is associated with a high risk of thiamine deficiency. Thiamine and glucose should be administered to patients experiencing or at high risk for Wernicke encephalopathy, a neurologic condition caused by chronic thiamine deficiency.[15,20,21]

The standard recommendation is to administer thiamine 100 mg IV prior to the glucose, but the necessity of this order of administration is currently under debate.[21] It had been theorized that administering glucose first might precipitate the development of Wernicke encephalopathy, but recent studies have suggested that when the thiamine is administered with or shortly after glucose, the risk is alleviated and necessary treatment of hypoglycemia—if present—may be initiated sooner.[15]

Additional nutritional deficits and imbalances, such as folic acid, magnesium, and other vitamins and minerals, may exist in patients with chronic AUDs. Literature concerning the overall impact of correcting these deficiencies is conflicting, but enteral or parenteral multivitamins and magnesium may be administered for replacement if appropriate.[22] Water and electrolyte disturbances should be corrected as well. Caution is important when rehydrating dehydrated patients because AWS patients may retain excess fluid, leading to fluid overload.[13] Physical restraints should generally be avoided, except when necessary to protect the patient or caregivers from harm.[22]