Benzodiazepine resistant alcohol withdrawal: What is the clinician's preferred definition?

What is it about?

Objectives: Although alcohol withdrawal is common, the recognition of benzodiazepine-resistant alcohol withdrawal is a relatively new concept. To provide a framework for both lit- erature review and future research, we assessed clinicians’ personal definition of resistant alcohol withdrawal. Method: We developed a cross-sectional web-based survey. Administrators from collaborating toxicology and emergency medicine associations deployed the survey directly to their respective memberships. Only physicians, pharmacists, and other clinicians routinely treating alcohol withdrawal were eli- gible to participate. Respondents selected their preferred defin- ition among the three most common author sources – JB Hack, NJ Benedict, D Hughes – or provided their own. Additional cri- teria to define resistant alcohol withdrawal were explored. Results: 384 individuals answered the survey. Respondents were mostly attending physicians (79%), in full-time practice (90%), in emergency medicine (70%), and from North America (90%). The majority (64%) described resistant alcohol withdrawal as a high benzodiazepine dosage. Seizures (26%) and persistent tachycardia (16%) were also main characteris- tics. The median dose to describe high benzodiazepine dose (n = 146) was 40 mg per hour of diazepam equivalents (IQR 20–50). Available definitions were ranked equally as the pre- ferred one: Hack (27%); Benedict (28%); Hughes (28%). Conclusion: Our results did not identify one single preferred definition for resistant alcohol withdrawal even though a high total dose of benzodiazepine is a major component. Hourly requirements of 40 mg of diazepam equivalents or more emerged as a possible threshold. These findings serve as a base to explore consensus guidelines or future research.

Featured Image