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UNMH Alcohol Withdrawal Protocol Based on and adapted from alcohol withdrawal protocol at Bayfront Medical Center CriticalCareNurse Vol 30, No. 3, June.

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Presentation on theme: "UNMH Alcohol Withdrawal Protocol Based on and adapted from alcohol withdrawal protocol at Bayfront Medical Center CriticalCareNurse Vol 30, No. 3, June."— Presentation transcript:

1 UNMH Alcohol Withdrawal Protocol Based on and adapted from alcohol withdrawal protocol at Bayfront Medical Center CriticalCareNurse Vol 30, No. 3, June 2010

2 CIWA is replacing CAGE Clinical Institute Withdrawal Assessment of Alcohol Validated in many other centers Multidisciplinary team developed the current protocol – Pharmacy, Neuro, Critical Care, Nursing – Trialed in MICU with good results – Modified from the current VA protocol as well Low intensity vs. High intensity

3 How to order Adult Alcohol Withdrawal Protocol-CIWA Pick dosing and pre-check all meds under the category Dose adjustment: >65 yo, Child’s B/C cirrhosis, severe neuro injury, pregnancy – Uses ativan only OR NO dose adjustment – Uses librium (or ativan if not taking po) Nurses do the rest with scoring and dosing of the meds

4 Total score is a simple sum of each item score (maximum score is 67). Score: <10: Very mild withdrawal 10-15: Mild withdrawal 16-20: Modest withdrawal >20: Severe withdrawal CIWA Scoring

5 Benzodiazepines Comparison Medication (action)Onset of action Dose Equivalent (mg) Average Half Life (Hr) in Healthy patient Active Metabolite and Metabolism Chlordiazepoxide (long) Oral 1-2 hrs Yes (Desmethyldiaz epam) CYP3A4 Diazepam (long) Oral, IV, rectal Almost immediate Yes (Desmethyldiaz epam) CYP3A4 Lorazapam (short) Oral, IV, IM 5-20 minutes No Glucuronide conjugation Oxazepam (short) Oral 1-2 hrs No Glucuronide conjugation


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