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most appropriate setting will be informed by a thorough clinical assessment -outpatient withdrawal -community residential withdrawal -hospital inpatient withdrawal
Alcohol withdrawal setting Outpatient withdrawal
Unsuitable :DTs, previous complicated withdrawal or a high level of alcohol dependence Dosing of benzo. should be reduced over period of withdrawal care should be taken not to over-sedate the client Ideally, clients should be monitored by a health professional for 4days of withdrawal and then every 2 days where clients are likely to experience a severe or complicated alcohol withdrawal syndrome
Hospital inpatient withdrawal
onset usually occurring 6²24 hours after the last drink Acute symptoms of mild to moderate withdrawal commonly include: · Agitation · Anxiety · Fever · Insomnia · Nausea · Nightmares · Restlessness · Sweats · Tachycardia · Tremor · Vomiting
serious features associated with alcohol withdrawal include: · Delirium Tremens (DTs) between two and five days after cessation · Symptoms : disorientation, anxiety and agitation, tremors, paranoia, hallucinations and fluctuating blood pressure Potentially life-threatening and requires immediate medical
arrest and death Hallucinations Increased agitation Seizures Wernicke·s encephalopathy
clinical assessment The likely severity Previous history of complicated withdrawal The client·s motivation for withdrawal care The client·s goals during withdrawal care Potential barriers that may impact on achieving the client·s goals Available support to enhance the likelihood of success
post-withdrawal plan Inclusion of family/significant others,
support Psychosocial interventions should explore: Client goals Perceived barriers to achieving goal/s An individual·s beliefs about withdrawal care Appropriate interventions and support services
preferred pharmacotherapy for managing alcohol withdrawal symptoms Prevent alcohol withdrawal seizures may prevent progression to delirium Long-acting benzodiazepines, are recommended considered once a client·s Blood Alcohol Level (BAL) is lower than 100. administer BDZ dosing based on CIWA-Ar conducted every 1 to 4 hours. Dehydration is common
Acamprosate Naltrexone disulfiram
treatment for seizures (for example with phenytoin, carbamazepine or sodium valproate) is not proven to have any clinical benefit.
essential component of the treatment consideration of additionalpharmacotherapies (acamprosate or naltrexone) Commence at the assessment phase of withdrawal care Support the client·s goals (accommodation, child protection, domestic violence and legal support) Involve family/significant others.