What is the treatment for alcohol overdose?

Treatment of Alcohol Overdose

The treatment of alcohol overdose requires immediate supportive care, including intravenous fluids, correction of electrolyte imbalances, thiamine administration, and benzodiazepines for withdrawal symptoms, with close monitoring of vital signs and mental status. 1

Initial Management

Assessment and Stabilization

• Assess airway, breathing, and circulation
• Monitor vital signs frequently
• Assess level of consciousness using Glasgow Coma Scale
• Evaluate for signs of trauma, hypothermia, or hypoglycemia

Supportive Care

• Intravenous fluid resuscitation to correct dehydration and hypotension
• Correction of hypoglycemia with glucose administration
• Warming measures if hypothermic
• Positioning to prevent aspiration if vomiting or decreased consciousness

Critical Interventions

• Thiamine administration: Must be given BEFORE any glucose-containing fluids 1, 2

  • 100-300 mg IV/IM for prevention of Wernicke encephalopathy
  • 100-500 mg IV/IM if Wernicke encephalopathy is suspected

• Electrolyte correction, particularly magnesium deficiencies 1

Management of Withdrawal Symptoms

Assessment

• Use Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale 1
  • Score >8: Moderate alcohol withdrawal syndrome
  • Score ≥15: Severe alcohol withdrawal syndrome

Pharmacological Management

• Benzodiazepines are the gold standard for alcohol withdrawal treatment 1, 3

  • Short-acting benzodiazepines (for patients with obesity or hepatic dysfunction):
    • Lorazepam 1-4 mg every 4-8 hours (PO/IV/IM)
  • Long-acting benzodiazepines (for patients without hepatic concerns):
    • Diazepam 5-10 mg every 6-8 hours (PO/IV/IM)
    • Chlordiazepoxide 25-100 mg every 4-6 hours (PO)

• Use symptom-triggered regimen rather than fixed-dose schedule to prevent drug accumulation 1

• Avoid antipsychotics as stand-alone treatment for alcohol withdrawal 1

Management of Benzodiazepine-Resistant Withdrawal

For patients not responding to standard benzodiazepine therapy, consider adjunctive treatments 3:

• Phenobarbital
• Dexmedetomidine
• Propofol (in ICU setting)
• Ketamine

Prevention of Complications

Nutritional Support

• Thiamine supplementation (as detailed above) 1, 2
• Multivitamin supplementation
• Correction of other nutritional deficiencies

Monitoring

• Regular assessment of vital signs
• Monitoring for seizures
• Observation for development of delirium tremens
• Liver function tests

Discharge Criteria and Follow-up

Discharge Criteria 1

• Fully alert and oriented
• Stable vital signs
• Able to ambulate safely
• No signs of withdrawal
• Safe discharge plan in place

Long-term Management

• Medications for maintaining abstinence 4, 1:

  • Acamprosate (most evidence for effectiveness): 1,998 mg/day for patients ≥60 kg
  • Naltrexone: Start with 25 mg for 1-3 days, then increase to 50 mg daily
  • Baclofen: Particularly beneficial for patients with liver disease

• Referral to specialized addiction services 1

• Engagement with mutual help groups like Alcoholics Anonymous 1

• Regular medical follow-up at least every 6 months 1

Common Pitfalls to Avoid 1

• Failing to administer thiamine before glucose
• Using antipsychotics alone for withdrawal management
• Inadequate dosing of benzodiazepines
• Not addressing psychiatric comorbidities
• Lack of follow-up planning
• Not involving family members in treatment

By following this comprehensive approach to alcohol overdose treatment, healthcare providers can effectively manage acute symptoms, prevent complications, and establish a foundation for long-term recovery.