Several papers over the last 20 years have shown the benefits of symptom-triggered therapy (STT) rather than a fixed-dose reducing schedule for alcohol withdrawal (see below for an example algorithm). The advantages include reduced length of stay, reduced rate of seizures and reduced cumulative dose of benzodiazepine. STT is also recommended by NICE in their 2010 guideline CG100 (updated in 2017), where they also recommend determining the severity of withdrawal with the help of a tool such as the CIWA-Ar, and that treatment should be withheld if there are no longer any symptoms of withdrawal. This is the first paper to consider this approach in the Emergency Department.

 

EMJ, October 2018

Example STT protocol: https://emergencymedicinecases.com/alcohol-withdrawal-delirium-tremens/