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- W4386584328 abstract "Figure: Managing Sedative-Hypnotic WithdrawalFigureA 24-year-old man was transferred from jail for altered mental status. The patient had been in jail for two days, and had developed worsening confusion and agitation. The patient was agitated, moving wildly, requiring physical restraints, and speaking incomprehensibly. His initial vital signs were notable for tachycardia (heart rate of 145 bpm) and hypertension (blood pressure of 140/100 mm Hg), and an afebrile core temperature. An examination revealed dilated pupils and dry skin. A point-of-care glucose measured 70 mg/dL. Midazolam 5 mg IV was administered due to his severe agitation and inability to cooperate with a detailed evaluation. The patient became somewhat more lucid after midazolam, though he appeared to be hallucinating. He reported a history of alprazolam use. The patient was treated with nutritional supplementation and escalating doses of benzodiazepines. He remained persistently agitated after a single dose of midazolam 40 mg IV, and phenobarbital was administered. The patient was also intubated for airway protection and anticipated clinical course. The patient was then started on a midazolam infusion at 40 mg/hour after which he became calmer and his vital signs normalized. Laboratory tests were unremarkable with the exception of an elevated CK. Head imaging was negative for acute intracranial processes. The patient was admitted to the intensive care unit where he was transitioned to propofol and dexmedetomidine infusions. He was eventually extubated and discharged on hospital day three with a chlordiazepoxide taper. Special thanks to David A. Tanen, MD, a professor of emergency medicine at Harbor-UCLA Medical Center, for his expertise and review of this algorithm. References Treatment Algorithms Crit Care Med. 2007;35(3):724. Ann Pharmacother. 2016;50[5]:389. Emerg Medicine Pract. 2017;19(3):1. Gabapentin Alcohol Clin Exp Res. 2009;33(9):1582. Ann Pharmacother. 2013;47(7-8):961. Barbiturates Am J Emerg Med. 2011;29(4):382. J Emerg Med. 2013;44(3):592. Textbook Chapters Cohen JP, et al. Alcohols in Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill Education, 2020. Quan D, et al. Benzodiazepines in Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill Education, 2020. Reviews JAMA. 1997;278(2):144. Arch Intern Med. 2004;164(13):1405. J Intensive Care Med. 2005;20(3):164. Amato, L., Minozzi, S., Vecchi, S. & Davoli, M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2011(6):CD008537." @default.
- W4386584328 created "2023-09-11" @default.
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- W4386584328 date "2022-02-22" @default.
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- W4386584328 doi "https://doi.org/10.1097/01.eem.0000821920.33486.22" @default.
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