Care of the ethanol intoxication, from agitation to withdrawal, is a topic of ongoing discussion. Some nice person ends up in the ED extremely intoxicated and agitated. What to do? Some would argue for an antipsychotic to control agitation. Effective? Very, but those are laden with side effects. Others argue for benzodiazepines. They are effective and safe. Most fall to using benzos. But the argument continues to rage. More research needs to be done.
But what about the chronic alcoholic going through acute withdrawal. Again benzodiazepines are the drug of choice. They are safe even in extremely large doses rarely causing respiratory depression. Unfortunately there is a subset of patients that are benzodiazepine resistant. There are many intensivists that prefer to use dexmedetomidine off-label. But the data on its use is scarce primarily case reports and case series. As a selective alpha-2 adrenergic agonist it makes since. It is sedating and controls the tremor, hypertension and tachycardia. There are also many who prefer the off-label use of ketamine for those difficult to manage patients. Ketamine is a NMDA blocker. Of course the data on it is in short supply but it is safe and appears to decrease the amount of benzodiazepines required and length of stay.
Just another fascinating discussion in the world of clinical toxicology.
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