The emergency medicine management of severe alcohol withdrawal.
Level 5 - mechanism / opinion, no new human data
Narrative review without systematic search or meta-analytic methodology
PubMed 28188055 · doi:10.1016/j.ajem.2017.02.002
What was done
The authors conducted an evidence-based clinical narrative review summarizing the pathophysiology, staging, and emergency medicine management strategies for severe alcohol withdrawal syndrome and delirium tremens.
What was found
The abstract reports no numerical data, effect sizes, or statistical comparisons. It reports that symptom-triggered benzodiazepines with rapid dose escalation remain the cornerstone first-line therapy. For treatment-resistant withdrawal, phenobarbital and propofol demonstrate management efficacy, with propofol usable as an induction agent. Dexmedetomidine does not treat underlying central nervous system pathophysiology but may reduce intubation rates. Ketamine requires further investigation. Outpatient management is noted as feasible only in patients with minimal symptoms.
Why it matters
This review outlines pharmacological escalation strategies for emergency clinicians when managing severe or benzodiazepine-refractory alcohol withdrawal.
Limits
As a narrative review, the abstract does not report a systematic search strategy, inclusion/exclusion criteria, quality appraisal of cited studies, or total sample size. No quantitative outcomes, comparative efficacy metrics, or safety data are provided.
Cited by
- supports Withdrawal from alcohol and benzodiazepines can be life-threatening.