Severe Alcohol Withdrawal

In this episode of Critical Matters, Dr. Sergio Zanotti interviews Dr. Nick Mark about the ICU management of severe alcohol withdrawal. Dr. Mark shares his experience with alcohol withdrawal, its prevalence, pathophysiology, clinical manifestations, and diagnosis, emphasizing the importance of considering it in all hospital patients. The discussion covers differential diagnosis, initial workup, and objective scoring frameworks. Treatment strategies, including symptom-based, fixed-dose, and front-loading approaches, are explored, along with specific medications like benzodiazepines, phenobarbital, propofol, and dexmedetomidine. Special situations such as withdrawal seizures and resistant alcohol withdrawal are addressed, as well as the importance of compassion and support for patients with alcohol use disorder.