There is no good evidence to support the use of IV fluids in resuscitation of patients with uncomplicated acute alcohol intoxication.
Most of our intoxicated patients are not vitamin deficient, and don’t need supplementation. The real kicker is that we almost never really try to find out if the patient might be a chronic abuser and potentially at risk. We just hang the bag. Remember, everything we do in medicine has a potential downside. And if the patient really doesn’t need a banana bag in the first place, there is no benefit to balance that risk. The next time you ask for that little yellow bag, think again!
The CAGE questions are 4 simple and easy-to-remember to screen for alcohol use problems. CAGE is a screening tool: screening measures are NOT intended to provide a diagnosis; diagnosis occurs if/when a patient screens positive. An abnormal or positive screening result may thus “raise suspicion” about the presence of an alcohol use problem, while a normal or negative result should suggest a low probability of an alcohol use problem.
For those dealing with alcohol withdrawal in Kenya…the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) objectifies alcohol withdrawal symptoms to help guide therapy;
Recently the New England Journal published a review article about delirium tremens which is somewhat misguided (see a scathing critique by The Poison Review). The article focused on traditional benzodiazepine therapy, overlooking recent evidence about phenobarbital. This post will explore how phenobarbital might fit into the treatment regimen for delirium tremens.