Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Alcohol Withdrawal Ed Inpatient, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CBC/BMP (Baseline labs), CXR/targeted imaging (Common ED complaints), Troponin/EKG (chest pain) (ACS rule-out). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Analgesics, Antiemetics. Use validated frameworks (e.g., Common Benzodiazepine Strategies) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Epidemiology / Risk Factors
- Varies by presentation; age/comorbidities matter
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC/BMP | Baseline labs | Abnormalities | |
| CXR/targeted imaging | Common ED complaints | Findings vary | |
| Troponin/EKG (chest pain) | ACS rule-out | MI changes | Use risk tools |
Common Benzodiazepine Strategies
| Drug | Typical Use | Notes |
|---|---|---|
| Diazepam | Front loading in ED | Long half life; avoid in severe liver failure |
| Lorazepam | Symptom triggered or fixed | Preferred in liver disease |
| Phenobarbital | Adjunct or alternative | Use with caution; monitor respiration |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Benzodiazepine (diazepam/lorazepam) | GABA-A potentiation | Minutes | Symptom-triggered therapy | Respiratory depression; ED use |
| Thiamine (before glucose) | Cofactor replacement | Hours | Prevent Wernicke’s | Anaphylaxis (rare IV); ED use |
| Adjuncts (phenobarb, dexmedetomidine) | GABAergic/α2 | Minutes | Refractory cases | Hypotension; ED use |
Prognosis / Complications
- Outcomes tied to emergency and timeliness of care
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Replete magnesium and phosphate. Avoid antipsychotics as sole agents for withdrawal; they are adjuncts for agitation after benzodiazepines.