Resistant alcohol withdrawal: Does an unexpectedly large sedative requirement identify these patients early?
88
Citation
10
Reference
10
Related Paper
Citation Trend
Keywords:
Vital signs
Sedative/hypnotic
Elevated plus maze
Cite
Citations (13)
The authors studied 50 of 55 patients originally hospitalized for primary sedative-hypnotic dependence 4-6 years after hospital discharge. Forty-two (84%) of the patients had resumed using sedative-hypnotics, 26 (52%) were abusing drugs at follow-up, and 21 (42%) had been readmitted for drug abuse. Three patients experienced delirious states and six experienced epileptic seizures associated with withdrawal. Physical signs of alcoholism had developed in 11 (22%); four (8%) had committed suicide. Social deterioration was noted in 24 patients. CAT scan results did not deviate from those found in a matched control sample.
Sedative/hypnotic
Cite
Citations (46)
The clinical characteristics and management of patients who abuse high doses of benzodiazepines are not well described. In a prospective open study, 23 subjects who abused high doses of benzodiazepines were admitted for detoxification. Urine or blood test results confirmed benzodiazepine use in all but one subject and multiple drug use in eight (35%). Median benzodiazepine dose was 150 mg (range 40 to 500 mg) of diazepam equivalent. Initial plasma concentrations (diazepam: median = 1245 ng/ml; desmethyldiazepam: median = 2961 ng/ml) were 400% to 800% higher than usual therapeutic concentrations. For detoxification, subjects were given a loading dose of diazepam equal to approximately 40% their reported daily consumption. This was followed with daily tapering of diazepam by 10%. This regimen resulted in a slow and gradual decline in drug concentrations. Withdrawal symptoms were assessed daily. Sixteen subjects completed detoxification in the hospital without complications. One subject became paranoid and confused on day 7 of withdrawal. This was attributed to a too-low initial loading dose and too-rapid tapering, which resulted in rapid drug elimination. Gradual reduction of diazepam dose appears to be an effective and safe approach for detoxifying abusers of high doses of benzodiazepines.
Detoxification
Regimen
Cite
Citations (57)
Cite
Citations (4)
Sedative/hypnotic
Cite
Citations (4)
The purpose of this study was to reduce numbers of concurrently ordered sedative-hypnotic drugs for older adults in long-term (N = 220) and home-care (N = 357) settings. All active records were reviewed and numbers of sedative-hypnotics per patient were documented. Upon record review completion, educational sessions focused on dangers posed by use of multiple sedative-hypnotics were presented to nurses. One month posteducation, researchers reviewed the same records to evaluate changes. Matched pair t-tests suggested significant decreases in sedative-hypnotic use in long term, but not in the home care setting. Education in this area is critical within and across community settings.
Sedative/hypnotic
Cite
Citations (2)
Flumazenil
Cite
Citations (97)
Depressant
Oxazepam
Cite
Citations (41)
Silastic
Physical dependence
Convulsion
Cite
Citations (38)