Clinical Pathways
Clinical Pathways
Symptoms not controlled
Symptoms not controlled

Symptoms not controlled

View The Full Pathway

Action

  • Administer escalating doses of benzodiazepines: (Class III)
    • Diazepam 20 mg, 50 mg, 100 mg IV every 10 min

      • or

    • Lorazepam 4 mg, 8 mg, 16 mg IV every 15-20 min
  • Re-evaluate in 10-15 min.

Decision

Are the patient’s symptoms controlled?

Yes

  • Admit the patient to a monitored unit or inpatient detoxification
  • Administer benzodiazepines (diazepam or lorazepam) if needed, based on CIWA-Ar score (or other validated tool) (Class I)

No

  • Continue high-dose benzodiazepines (Class I)
  • Consider adjunctive phenobarbital, 10 mg/kg IV x 1 (Class I)
  • Consider adjunctive ketamine 0.3 mg/kg IV bolus, 0.3 mg/kg/hr infusion (Class III)
  • Admit to ICU

Background

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References
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