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February 1978

Management of Alcohol Withdrawal Syndromes

Author Affiliations

From the Clinical Pharmacology Program, Departments of Medicine and Pharmacology, Case Western Reserve University and University Hospitals of Cleveland. Dr Thompson is a Burroughs Wellcome Scholar in Clinical Pharmacology.

Arch Intern Med. 1978;138(2):278-283. doi:10.1001/archinte.1978.03630260068019

Withdrawal from alcohol (ethanol, ethyl alcohol) or other general sedatives leads to progressive hyperactivity that progresses from tremulousness, sleep disturbance, and hallucinosis, to the more serious rum fits and delirium tremens (DTs). Withdrawal can be prevented and, in most cases, arrested by prompt replacement of alcohol with paraldehyde, benzodiazepines or other general sedatives. Diazepam is appropriate replacement therapy for most patients. When delirium is manifest, the chance is greater than 15% that the patient will die, and this reaction cannot be aborted. The patient with DTs must be calmed with a general sedative that has a rapid onset of maximal effect to prevent overdosage. Diazepam, 5 mg intravenously every five minutes, permits evaluation of the maximal effect of each dose before the next dose is administered. Although some patients have advanced sedative or alcohol withdrawal, great care must be taken to elicit the proper history of alcohol abuse so that sedative replacement therapy will prevent or abort early withdrawal, thus sparing the patient a mortality equivalent to that of acute myocardial infarction or Russian roulette.

(Arch Intern Med 138:278-283, 1978)