Treatment is largely supportive without the need for any pharmacologic intervention in the ED unless there is serious hemodynamic abnormalities
PO/IV hydration
Electrolyte repletion<unk>  administration such as morphine can be given as needed for symptom control
A central α2 agonist that does suppress the sympathetic hyperactivity that results during acute withdrawal
Dosing:  0.1mg PO (or 5mcg/kg PO if SBP >90 mmHg) every 60 minutes as needed for sympathetic symptoms
Major adverse effect is hypotension
Clonidine patches are not useful for acute withdrawal due to the 24hr delayed release[citation needed]
Major adverse effect is hypotension
A newer central alpha2 agonist
Generally reserved for outpatient therapy
Decreases serotonergic activity
Can be added along with with clonidine for adequate sedation
Consider if withdrawal was precipitated by interruption in<unk>  use, NOT if antagonist (e.g. narcan) was given
Dose: 10mg IM or 20mg PO
Opioid withdrawal
Differential is largely based on clinical symptoms and history
Benzodiazepine withdrawal
Sepsis
Cocaine withdrawal
Influenza
Alcohol withdrawal
Clonidine withdrawal