The Internet Book of Critical Care Podcast
IBCC Episode 45 ETOH Withdrawal
Jul 20, 2019
Exploring the efficacy of phenobarbital over benzodiazepines in alcohol withdrawal treatment, focusing on dosing, indications, and adjuvant therapies. Detailed discussions on managing withdrawal symptoms, assessment scales, and phenobarbital level checking. Comparison of using IV-diazepam and ketamine for initial behavioral control in agitated patients. Highlighting treatment strategies with dexmetatomidine, IV haloperidol, and anticonvulsants for alcohol withdrawal management.
53:33
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Quick takeaways
- Phenobarbital addresses GABA and glutamate imbalances in alcohol withdrawal, offering a different therapeutic model from benzos.
- Caution is advised in patients with unclear alcohol withdrawal diagnosis or severe hepatic encephalopathy when using phenobarbital.
Deep dives
Therapeutic Benefits of Phenobarbital in Alcohol Withdrawal Treatment
Phenobarbital, historically a frontline agent for alcohol withdrawal, offers a therapeutic model different from the current benzos trend. Its efficacy, tied to its synergistic effect on neurotransmitters, addresses both GABA and glutamate imbalances in patients undergoing withdrawal. The drug's long half-life, linear relationship between dose and drug levels, and low sedation effects at moderate doses make it a precise and safe choice. Phenobarbital's predictability in pharmacokinetics, potential for seizure prevention, all-route administration, and availability contribute to its superiority over benzos in many cases.
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