Alcoholism detoxification

Volkow ND, Wang GJ, Overall JE, et al Regional brain metabolic response to lorazepam in alcoholics during early and late alcohol detoxification. Alcohol Clin Exp Res 21 1278-1284, 1997... 

Disulfiram An inhibitor of hepatic aldehyde dehydrogenase that converts acetaldehyde (a metabolite of alcohol) into acetic acid. It is used to prevent relapse following alcohol detoxification. 

Nimodipine A voltage-operated Ca2+ channel blocker with potential benefits in treating cognitive deficits and managing opiate and alcohol detoxification. 

When used for detoxification, phenobarbital is given in equal doses four times a day. The maximum daily dose of phenobarbital is 600 mg, but much lower doses are usually sufficient. The phenobarbital dose is lowered (i.e., tapered) by about 20% per day. If the patient is too drowsy, then a dose should be skipped. If breakthrough withdrawal symptoms continue to occur, then the pace of the detoxification should be slowed. Before using phenobarbital, liver function tests should be obtained. All barbiturates depend greatly on the liver to be metabolized. Alcoholics with cirrhosis or other forms of liver impairment may have difficulty clearing phenobarbital. Phenobarbital should not be used in patients with poor liver function. In addition, the barbiturates can worsen a medical condition known as porphyria and should be avoided in those with this disorder. Phenobarbital, as noted, is seldom used today for alcohol detoxification. 

Benzodiazepines. Like the barbiturates, benzodiazepines bind to the GABA receptor and are therefore cross-tolerant with alcohol. As a result, they also make suitable replacement medications for alcohol and are widely used for alcohol detoxification. Theoretically, any benzodiazepine can be used to treat alcohol withdrawal. However, short-acting benzodiazepines such as alprazolam (Xanax) are often avoided because breakthrough withdrawal may occur between doses. Intermediate to long-acting benzodiazepines including chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serax), lorazepam (Ativan), and clonazepam (Klonopin) are more commonly utilized. 

Nutrient supplementation during alcohol detoxification includes thiamine, magnesium sulfate, folic acid, and a multivitamin. During the rehabilitation and continuing care stages of treatment for alcohol dependence, nutrient supplementation includes thiamine and a multivitamin. 

With drugs that produce a depression after chronic exposure (e.g., alcohol), detoxification is instituted, in addition to supportive care and therapy for substance dependency. Even though most alcoholics will experience depression immediately after the cessation of heavy and prolonged consumption, the majority will remit within several weeks following detoxification and supportive care (see Chapter 14, The Alcoholic Patient ). For those who do not, it is likely there had been a preexisting depressive disorder, which itself can lead to substance dependency, because patients frequently self-medicate before seeking professional intervention. This possibility should be evaluated through a review of the patient s personal medical and psychiatric history, as well as family history. 

A 31-year-old white man with depression, hepatitis C, and cirrhosis of the liver was hospitalized for alcohol detoxification. He had taken methadone 50 mg bd for opium dependence for 6 months. He developed bilateral pedal edema and 27 kg weight gain. There was no ascites, portal hypertension, or congestive heart failure. Most of his laboratory tests were within the reference ranges, except for reduced prothrombin time and platelet count. After stopping alcohol, his methadone dose was reduced to 60 mg/day his edema resolved 15 days later. When the dose of methadone was increased to 70 mg/day there was a progressive increase in the edema. When methadone was withdrawn his edema completely resolved and he lost 8 kg in 2 weeks. 

Reoux JP, Miller K. Routine hospital alcohol detoxification practice compared to symptom triggered management with an objective withdrawal scale (CIWA-Ar). Am J Addict 2000 9 135-144. 

Chlordiazepoxide (Librium), a benzodiazepine, to a client admitted for alcohol detoxification. 

In a randomised, placebo-controlled study, there was no difference in measures of hepatotoxicity (mean AST levels, mean INR) between 102 alcoholic patients who received paracetamol 1 g four times daily for 2 days, and 99 alcoholic patients who received placebo. In this study, patients had entered an alcohol detoxification centre, and were given paracetamol im-... 

Opiate/alcohol detoxification is rislqr once pregnant try to organise beforehand... 

Diazepam Tablets/IV/ PR 2.5- 5 30 Sedation Alcohol detoxification/seizures (>BNF doses may be needed) IV rarely used in psychiatric units, for RT... 

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