In her study, published in Australian Critical Care (24(2), 110-116, 2011), Flora A. Corfee examines the unique challenges faced by critical care nurses in managing patients affected by acute alcohol withdrawal, associated alcohol-induced illness, or an unrelated admission with underlying heavy alcohol intake. This subject is particularly pertinent to Australian critical care nurses, with statistics showing that one in five Australians regularly drink to risky levels and that there are around 72,000 alcohol-related hospital admissions a year.
 

While alcohol withdrawal can be divided into four stages, most presentations to critical care occur in the late stage of withdrawal and are characterised by delirium, seizures, and associated sequelae, including life-threatening electrolyte imbalance, respiratory failure, hepatic failure, and gastro-intestinal disease. Patients who are experiencing these symptoms are admitted to a critical care unit to optimise multi-organ function and manage delirium and seizures.
 

According to the author, much of the literature related to the subject supports the use of benzodiazepine therapy as the most common frontline treatment for acute alcohol withdrawal, despite some of its potential side effects, such as sedation and toxicity. However, emerging research is increasingly turning to adjunctive therapies, such as Propofol, Dexmedetomidine and Clonidine, and Sodium Valproate and Carbamazepine, to reduce benzodiazepine doses and shorten the length of stay in the critical care unit.
 

Ethanol replacement, a controversial treatment for acute withdrawal, is supported by the theory that controlled doses of ethanol can prevent the development of withdrawal symptoms while staff can manage titration and weaning. However, The American Society of Addiction Medicine does not support the use of ethanol, based on the lack of sufficient empirical evidence and the risk of systemic toxic effects.

 

Nursing management of patients experiencing alcohol withdrawal should focus on data, such as neurological assessment, electrolyte values, and haemodynamic monitoring. To achieve this, regular assessments must be undertaken, with particular attention to the onset of Wernicke—Korsakoff syndrome, which can be prevented with thiamine replacement. Electrolyte balances can be managed by monitoring manifestations of deranged potassium, magnesium, sodium and phosphate levels.

 

One of the major challenges faced by staff treating withdrawal patients is extracting information from the patients, who often present in states of delirium, are already intubated, or are critically ill. While attempts at scales and protocols continue to be explored there is still no final practical assessment scale to manage patients that cannot provide subjective information.

 

The author concludes that benzodiazepine therapy is the accepted standard for treatment of acute withdrawal in critical care. "However, current literature indicates the absence of evidence-based drug protocols, dosage regimes and an assessment scale to manage patients withdrawing from alcohol in critical care settings," raising the need for further research into "validated withdrawal assessment tools."