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Alcohol withdrawal

  • Admission orders

    • Admit: Floor
    • Diagnosis: Alcohol Withdrawal
    • Condition: Stable
    • Vital Signs: q 2 hours x 4, then q 4 hours
    • Allergies:
    • Nursing: CIWAA on admission, q 2 hours x 4, then if score < 9, q 4 hours
    • Diet: NPO if AMS
    • Activity: Bedrest, Fall Precautions
    • Labs:
      • CBC
      • Chem, Mg qday
      • Ca, PO4
      • LFTs
      • Coags: INR
      • blood cultures x 2
      • UA
      • EKG
      • CXR
    • IV: NS 250 mL/h for 1 Liter, Followed by D5 1/2 NS at 100 mL/h
    • Special: social work, substance abuse counselling, psych consult for depression
    • Medications:
      • Chlordiazepoxide 25 mg PO q 2-4 hours prn CIWAA score 9-15 (50 mg if CIWAA > 15)
      • Thiamine 100 mg PO qd for 3 days
      • Multivitamin PO qd
      • Folic acid 1 mg PO qd
      • Replete Mg prn hypomagnesemia
    • Call HO: temp > 38.5 C, HR > 110, SBP > 180
  • Discharge

    • criteria
      • no longer drunk
      • no longer requiring prn BZDs
      • tolerating PO
      • stable
    • education: substance abuse, AA, rehab

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