Table 4.

Immediate issues in the care of chronic heavy drinkers admitted to the hospital

Clinical issue	Treatment
Assess risk for nutritional deficiency	• Thiamine supplementation.
	• Possibly folate and multivitamin supplement.
Assess hydration status and electrolytes (risk for hypocalcemia and hypomagnesemia with or without hypokalemia and hypophosphatemia)	• IV or oral fluids.
	• Oral or IV electrolyte replacement.
Risk for acute alcohol withdrawal	• Close observation with validated instrument or prophylactic benzodiazepine, particularly in those with previous withdrawals or history of severe withdrawal (delirium tremens or seizure).
	• Prophylaxis still requires close observation for over or under-sedation.
Active alcohol withdrawal	• Symptom-triggered or scheduled benzodiazepine.
	• Close observation with validated instrument with either symptom-triggered or scheduled dosing.
	• Alternate medication (e.g., phenobarbital) in rare event that benzodiazepine is unsuccessful at controlling agitation.
	• Possible beta blocker or clonidine for autonomic manifestations if benzodiazepine alone is insufficient.
	• Possible haloperidol if benzodiazepine alone is insufficient for delirium.
	• Consider other causes of delirium.