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Management of Alcohol Withdrawal Delirium
An Evidence-Based Practice Guideline
Michael F. Mayo-Smith, MD, MPH;
Lee H. Beecher, MD;
Timothy L. Fischer, DO;
David A. Gorelick, MD, PhD;
Jeanette L. Guillaume, MA;
Arnold Hill, MD;
Gail Jara, BA;
Chris Kasser, MD;
John Melbourne, MD; for the Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine
Arch Intern Med. 2004;164:1405-1412.
Background Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal. Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable.
Methods Articles with original data on management of alcohol withdrawal delirium underwent structured review and meta-analysis.
Results Meta-analysis of 9 prospective controlled trials demonstrated that sedative-hypnotic agents are more effective than neuroleptic agents in reducing duration of delirium and mortality, with a relative risk of death when using neuroleptic agents of 6.6. Statistically significant differences among various benzodiazepines and barbiturates were not found. No deaths were reported in 217 patients from trials using benzodiazepines or barbiturates.
Conclusions Control of agitation should be achieved using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol. Adequate doses should be used to maintain light somnolence for the duration of delirium. Coupled with comprehensive supportive medical care, this approach is highly effective in preventing morbidity and mortality.
From the Primary Care Service, Veterans Administration Medical Center, Manchester, NH (Dr Mayo-Smith); the Tri County Commission on Alcohol and Drug Abuse, Orangebury, SC (Dr Fischer); the Intramural Research Program, National Institute on Drug Abuse, Baltimore, Md (Dr Gorelick); the American Society of Addiction Medicine, Chevy Chase, Md (Mss Guillaume and Jara); Marlboro Medical Center, Marlborough, Mass (Dr Hill); Kasser & Associates, Cordova, Tenn (Dr Kasser); and Conifer Park Rehabilitation Center, Scotia, NY (Dr Melbourne). Dr Beecher is in private practice in St Louis Park, Minn. The authors listed in the byline constitute the Working Group on the Management of Alcohol Withdrawal Delirium. The authors have no relevant financial interest in this article.
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