RESUMEN
BACKGROUND: Alcohol withdrawal can lead to severe complications including seizures, delirium tremens, and death if not treated appropriately. Nurses are critical to the safety and outcomes of these patients. OBJECTIVE: The objective of this retrospective study was to determine if nursing education on a community hospital's alcohol withdrawal protocol led to improved nursing compliance. METHODS: This is a quality improvement project involving a two-part retrospective review-an initial needs assessment followed by nursing education and a subsequent posteducation retrospective review. The initial needs assessment included 65 patients. The subsequent posteducation group included 50 patients. RESULTS: Nursing compliance of 1-hour assessments increased after the educational intervention; however, there was no statistically significant difference in 6-hour assessment or medication administration protocol compliance between preeducation and posteducation groups. CONCLUSION: Nursing education is a good place to start in improving compliance with an alcohol withdrawal protocol, but physicians need to be included to increase standardization within the institution. Future study should look at the effectiveness of different assessment frequency intervals and its impact on patient-centered outcomes.
Asunto(s)
Convulsiones por Abstinencia de Alcohol/rehabilitación , Trastornos Inducidos por Alcohol/rehabilitación , Árboles de Decisión , Pautas de la Práctica en Enfermería/normas , Convulsiones por Abstinencia de Alcohol/enfermería , Trastornos Inducidos por Alcohol/enfermería , Protocolos Clínicos , Femenino , Humanos , Capacitación en Servicio , Masculino , Persona de Mediana Edad , North Carolina , Garantía de la Calidad de Atención de Salud , Estudios RetrospectivosRESUMEN
In the summer, alcohol consumption increases and the number of those requiring rehabilitation peaks at the end of the holiday season. Treatment of alcohol withdrawal symptoms early enough helps the patient to break the drinking cycle. Treatment of alcohol withdrawal symptoms will also prevent complications, such as convulsions and alcoholic delirium. Untreated alcoholic delirium is a life-threatening condition. Treatment aims to calm down the hyperactivity state of the autonomous nervous system, and correct electrolyte and fluid balance disturbances. Initiation of rehabilitation is determined by the severity of the patient's withdrawal symptoms. Benzodiazepines are the first-line drugs.
Asunto(s)
Delirio por Abstinencia Alcohólica/rehabilitación , Convulsiones por Abstinencia de Alcohol/rehabilitación , Delirio por Abstinencia Alcohólica/fisiopatología , Convulsiones por Abstinencia de Alcohol/fisiopatología , Sistema Nervioso Autónomo/fisiopatología , Benzodiazepinas/uso terapéutico , Humanos , Estaciones del Año , Desequilibrio Hidroelectrolítico/fisiopatología , Desequilibrio Hidroelectrolítico/terapiaRESUMEN
INTRODUCTION: Delirium tremens and withdrawal seizures are serious complications of an alcohol withdrawal syndrome. This review presents the diagnostic procedures required in case of the occurrence of a withdrawal seizure and delirium tremens as well as possible treatment options including prophylactic medication regimen for alcohol withdrawal syndrome. Furthermore non-pharmacological procedures accompanying delirium tremens and a potential integration of viewing videotapes of delirium tremens in the course of alcohol-specific therapy are discussed. METHODS: A systematic literature research using Pubmed has been carried out to find recent studies and review articles dealing with alcohol withdrawal syndrome. RESULTS AND DISCUSSION: Regarding the diagnostic algorithm in case of the occurrence of a withdrawal seizure or a delirium tremens basic diagnostic procedures and special diagnostics including neuro-imaging or cerebrospinal fluid puncture depending on patients' clinical condition have to be considered. Sedatives are important in treatment of alcohol withdrawal seizures and delirium tremens as well as in the prophylaxis of alcohol withdrawal syndrome. A long-lasting prescription of anticonvulsant medication in patients suffering from withdrawal seizure should be considered critically and can be carried out only under certain conditions.
Asunto(s)
Delirio por Abstinencia Alcohólica/diagnóstico , Delirio por Abstinencia Alcohólica/rehabilitación , Convulsiones por Abstinencia de Alcohol/diagnóstico , Convulsiones por Abstinencia de Alcohol/rehabilitación , Alcoholismo/rehabilitación , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/efectos adversos , Delirio por Abstinencia Alcohólica/clasificación , Delirio por Abstinencia Alcohólica/prevención & control , Convulsiones por Abstinencia de Alcohol/clasificación , Convulsiones por Abstinencia de Alcohol/prevención & control , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/efectos adversos , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Benzodiazepinas/administración & dosificación , Benzodiazepinas/efectos adversos , Clordiazepóxido/administración & dosificación , Clordiazepóxido/efectos adversos , Clormetiazol/administración & dosificación , Clormetiazol/efectos adversos , Terapia Combinada , Comorbilidad , Diagnóstico Diferencial , Esquema de Medicación , Interacciones Farmacológicas , Etanol/sangre , Etanol/toxicidad , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Prevención SecundariaRESUMEN
AIMS: Anticonvulsants are increasingly being advocated for the treatment of acute alcohol withdrawal syndrome (AWS) to avoid the addictive properties of established medications. Because earlier works showed that moderate gabapentin doses were too low to clearly ameliorate severe AWS, we tested a higher gabapentin entry dose. METHODS: Inpatients (n = 37) with severe alcohol withdrawal symptoms (Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-AR) score > or =15 points) were given gabapentin 800 mg, and if their symptom score reduced within 2 h, they were termed 'early responders' and were then treated for 2 days with 600 mg gabapentin q.i.d. (i.e. a total of 3200 mg in the first 24 h) before beginning a taper. RESULTS: Twenty-seven (73%) were early responders (baseline CIWA-AR improved from 17.3 +/- 2.6 to 8.0 +/- 3.6 points). In the remaining 10 patients, baseline CIWA-AR deteriorated within 2 h (from 20.1 +/- 4.6 to 21.5 +/- 4.65 points). These patients were switched to clomethiazole (n = 4) or clonazepam (n = 6), which is the usual treatment. Three of the 'early responders' worsened in the next 36 h and were then reclassified and treated as 'non-responders'. Among them, two developed an epileptic seizure. CONCLUSION: Oral 800 mg gabapentin (loaded up to 3200 mg in the first 24 h) is helpful only in reducing less severe and less complicated acute AWS.