Phenobarbital monotherapy algorithm for alcohol withdrawal

** EDIT - SEE UPDATED ALGORITHM HERE:

https://www.grepmed.com/images/4060/phenobarbital-monotherapy-withdrawal-management-algorithm-protocol-pulmcrit

-Phenobarbital monotherapy has numerous advantages compared to benzodiazepines. Emerging evidence suggests that translates into meaningful clinical benefit.
-If 15 mg/kg phenobarbital fails to achieve clinical resolution, this suggests that the patient may have another problem in addition to alcohol withdrawal.  Alternative causes of delirium should be explored.
-For severely agitated patients, dexmedetomidine can be useful initially to gain behavioral control.  However, phenobarbital should be rapidly up-titrated to treat the underlying disorder and avoid seizure.
-An updated approach to phenobarbital use is suggested (figure below).
-If you work at a center that is using lorazepam for alcohol withdrawal, the current shortage of lorazepam isn't a threat – it's an opportunity to move to a superior therapy.
#Management #Alcohol #EtOH #Withdrawal #Phenobarbital #Monotherapy #Algorithm #Protocol #PulmCrit