Issues on sedating mental patients
They usually are single seizures that last less than five minutes, but some patients have seizures in salvos of two or three.
Status epilepticus is not associated with alcohol withdrawal and indicates another problem.
Heavy drinkers should receive a brief intervention designed to moderate their drinking.7.9 Approximately 5 percent of the patients in a typical adult primary care practice would be expected to have alcohol dependence.10 In patients without acute medical or surgical problems, about one third would be expected to develop mild to moderate AWS (e.g., tremulousness, tachycardia), and only a small minority would be expected to develop severe AWS if they abruptly stopped drinking.113 In one study11 of 1,024 ambulatory patients undergoing detoxification without psychoactive drugs, 3.7 percent experienced hallucinations, 1.2 percent had alcohol withdrawal seizures, and 1 percent developed delirium tremens.
Patients who are at risk for AWS may benefit from pharmacotherapy.
Liberal intake of noncaffeinated fluids can help prevent dehydration.
Medications are used to prevent or treat the various clinical manifestations of AWS: sedatives for CNS excitation; sympatholytics for excessive ANS activity not controlled by sedatives alone; and neuroleptics as adjunctive therapy for cognitive dysfunction.13Thiamine supplementation is essential in malnourished patients for the prevention of Wernicke's encephalopathy.
Long-acting benzodiazepines are the agents of choice for monotherapy in patients with AWS.2327 In clinical practice, the effective dosage can vary greatly from one patient to another.Long-acting benzodiazepines, the preferred medications for alcohol detoxification, can be given on a fixed schedule or through “front-loading” or “symptom-triggered” regimens.Adjuvant sympatholytics can be used to treat hyperadrenergic symptoms that persist despite adequate sedation.At-risk drinking is defined as more than 14 drinks per week in men under age 65 and more than seven drinks per week in women and all adults aged 65 and older.One standard drink is equal to 12 oz of regular beer, 5 oz of wine, or 1.5 oz of distilled spirits.
Stage 3, “delirium tremens,” can occur from 72 to 96 hours after the last drink.