Selected Topics: Psychiatric Emergencies
Psychiatric Emergencies for Clinicians: Emergency Department Management of Alcohol Withdrawal

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Clinical Scenario

A 50-year-old woman with schizophrenia was brought in by staff from a homeless shelter for cough. She complained of productive, nonbloody sputum for 3 days without shortness of breath. Her vital signs on presentation were 99.0°F (37.2°C), pulse 100 bpm, blood pressure 130/90 mm Hg, respiratory rate 18 breaths/min, and pulse oximetry 94% on room air. Her blood alcohol concentration (BAC) by breathalyzer was 70 mg/dL. The patient was thin, disheveled, and comfortable; she was triaged to a hallway

Clinical Bottom Lines

  • The risk for alcohol withdrawal should be considered in the treatment and discharge planning of all patients with an alcohol use disorder

  • Alcoholism and alcohol withdrawal are life-threatening illnesses. Medical comorbidity is common

  • Benzodiazepines are the mainstay of treatment for alcohol withdrawal, although other agents may be considered

  • Treatment of alcohol withdrawal in the emergency department reduces mortality

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