What are the discharge criteria from acute care for patients with alcohol withdrawal syndrome?

From the Guidelines

Patients can be safely discharged from acute care following alcohol withdrawal when they demonstrate clinical stability, including vital signs within normal limits for at least 24 hours, resolution of withdrawal symptoms (CIWA-Ar score consistently below 8-10), ability to tolerate oral intake, and absence of significant psychiatric or medical complications.

Discharge Criteria

The discharge criteria for patients with alcohol withdrawal should prioritize clinical stability and the absence of significant complications. Key factors to consider include:

• Vital signs within normal limits for at least 24 hours
• Resolution of withdrawal symptoms, as indicated by a CIWA-Ar score consistently below 8-10 1
• Ability to tolerate oral intake
• Absence of significant psychiatric or medical complications

Treatment and Management

Prior to discharge, patients should have completed the acute detoxification phase, typically lasting 3-5 days, with benzodiazepine tapers successfully discontinued or transitioned to outpatient regimens 1.

Discharge Planning

Discharge planning must include arrangements for follow-up addiction treatment, which may involve outpatient programs, counseling, or residential rehabilitation. Medications for alcohol use disorder maintenance, such as naltrexone (50mg daily), acamprosate (666mg three times daily), or disulfiram (250mg daily), should be considered and initiated when appropriate 1.

Patient Education

Patients should also receive education about relapse prevention strategies, recognition of withdrawal symptoms, and when to seek medical attention. This comprehensive approach ensures a safe transition from acute care while addressing the underlying alcohol use disorder to reduce readmission risk.

From the FDA Drug Label

In acute alcohol withdrawal, diazepam may be useful in the symptomatic relief of acute agitation, tremor, impending or acute delirium tremens and hallucinosis The FDA drug label does not answer the question.

From the Research

Discharge Criteria for Alcohol Withdrawal from Acute Care

• The decision to discharge a patient with alcohol withdrawal from acute care should be based on the severity of their symptoms and their response to treatment 2, 3, 4.
• Patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal can be treated as outpatients when possible 5.
• The Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale are two commonly used tools to assess withdrawal symptoms 5.
• Benzodiazepines are the drugs of choice for pharmacologic treatment of alcohol withdrawal, and their application by means of a symptom-triggered approach based on frequent, objective assessment of the patient is recommended 4, 6.
• The treatment of alcohol withdrawal should include supportive care and pharmacotherapy as appropriate, and patients should be monitored daily for up to five days after their last drink to verify symptom improvement and to evaluate the need for additional treatment 5.

Factors to Consider for Discharge

• The patient's ability to manage their withdrawal symptoms at home 5.
• The presence of any underlying medical or psychiatric conditions that may complicate their withdrawal 3, 4.
• The patient's social support system and access to follow-up care 2, 5.
• The patient's risk of developing severe or complicated withdrawal, such as seizures or delirium tremens 3, 6.

Pharmacotherapy for Alcohol Withdrawal

• Benzodiazepines, such as lorazepam or diazepam, are the first-line therapy for moderate to severe alcohol withdrawal symptoms 2, 6.
• Carbamazepine or gabapentin can be used as adjunctive or alternative therapies for mild symptoms or for patients who cannot tolerate benzodiazepines 5.
• The choice of pharmacotherapy should be based on the patient's individual needs and medical history 4, 6.