Goal = sleepy but arousable with HR <110
Escalating doses of benzodiazepines and phenobarbital
Diazepam IV pushes q5-10 min
10mg x2 → 20mg x3 → 40mg x3 = 200mg total diazepam
If still agitated/hyperdynamic after 200mg of diazepam:
Phenobarbital IV push q5-10min, x3 escalating doses
Phenobarbital 65mg → 130mg → 260mg IV
If still agitated after phenobarbital → intubate and sedate with propofol and fentanyl
10mg x2 → 20mg x3 → 40mg x3 = 200mg total diazepam
Phenobarbital IV push q5-10min, x3 escalating doses
Phenobarbital 65mg → 130mg → 260mg IV
Phenobarbital 65mg → 130mg → 260mg IV
At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
Give multivitamin PO; patient at risk for other vitamin deficiencies
The majority of chronic alcoholics do NOT require a banana bag
Thiamine 100mg IV
Folate 1mg IV (cheaper PO)
Multivitamin 1 tab IV (cheaper PO)
Magnesium sulfate 2mg IV
Normal saline as needed for hydration
The propylene glycol diluent in lorazepam, phenobarbital, and diazepam, may induce a hyperosmolar anion gap metabolic acidosis if given as a drip in high doses ≥ 48hrs
Consider alternatives such as propofol or dexmedetomidine if patients need long term sedation for<unk>
Delirium tremens
Ethanol toxicity
Excited delirium
Alcohol use disorder
Acute psychosis
Alcohol withdrawal
Alcohol withdrawal seizures
Beer potomania syndrome