Alcohol Withdrawal Delirium Clinical Trial
Official title:
Treatment Of Alcohol Withdrawal Syndrome: Dexmedetomidine Vs Diazepam In A Hospital O'horán
The cessation of alcohol consumption of people suffering from alcohol abuse frequently leads
to the development of an alcohol withdrawal syndrome (AWS).
The ethylic suppression syndrome is defined as the appearance of two or more data of
autonomic hyperactivity, nausea, hallucinations and seizures associated with the cessation of
alcohol consumption. For its evaluation, the CIWA-Ar scale is used, which guides the
treatment based on benzodiazepines but with many adverse effects, so sedatives have been
tried, among them dexmedetomidine, an alpha-agonist with action in the locus caeruleus, with
variable results. Objectives: The investigators aimed to compare the DEX vs. Diazepam, for
moderate disease, applying the CIWA-Ar scale, in participants with severe to moderate AWS.
Methodology: 40 participants with CIWA-Ar greater than 10 points, the investigators are
collected and randomized into two groups: one under treatment with diazepam (Group Diazepam)
and another with dexmedetomidine (Group Dexmedetomidine), until the CIWA-Ar was reduced to
less than 10, and adverse effects the investigators also reported. The analysis was done with
student t. Results: The average duration of treatment with diazepam was 5.5 days (IC 95 =
6.6-3.8), the average duration of treatment with dexmedetomidine was 3.1 days (95% CI =
4.5-1.7), with a significant difference ( p = 0.0016). In the group with diazepam 60%
presented adverse effects and in the group with dexmedetomidine 25% presented them, with a
significant difference (p = 0.04). Conclusion: dexmedetomidine was superior to diazepam for
the treatment of moderate-severe alcohol withdrawal with fewer adverse effects.
KEY WORDS: Alcohol dependence · Alcohol withdrawal syndrome · Dexmedetomidine · Diazepam ·
Benzodiazepines
Alcohol withdrawal syndrome AWS (Alcohol Withdrawal Syndrome), is defined as the appearance
of two or more data of autonomic hyperactivity, nausea, hallucinations and seizures
associated with cessation of alcohol consumption. For its evaluation, the CIWA-Ar (Clinical
Institute Withdrawal Assessment for Alcohol) scale is used, which guides the treatment based
on benzodiazepines but a disadvantage is the related adverse effects, for which other
pharmacological strategies of sedation have been tried, among them Dexmedetomidine (DEX).
OBJECTIVES:
The investigators aimed to compare the DEX vs. Diazepam, for moderate disease, applying the
CIWA-Ar scale, in participants with severe to moderate AWS (Alcohol Withdrawal Syndrome).
MATERIALS:
Prior authorization from the ethics committee of O'Horán Hospital, Yucatán, Mexico. No.
Registration CEI-011-1-17, and signature of informed consent. A randomized clinical trial was
carried out in the Adult Emergencies service during the period July 2017-July 2018. Forty
participants with CIWA-Ar greater than 10 points participated. The administration of:
A) Diazepam 5-20 mg IV. B) DEX 0.2-0.7 mcg / Kg / min., until the CIWA-Ar scale decreases to
<10.
The investigators are excluded minor patients, mild CIWA-Ar category, previous medication,
participants with severe cranial encephalic trauma (TBI) or mechanical ventilation
requirement, with chronic liver failure category C in the Child-Turcotte-Pugh classification.
RESULTS
The CIWA Ar scale average for admission was 23 points, the lowest of 10 points and the
highest of 38 points. The average number of days consuming alcohol prior to hospital
admission was 131.9, with the highest average in the group that used dexmedetomidine; the
average number of days after having suspended the intake until hospital admission was 1.7
days, being slightly higher in the group that used diazepam; the shortest time was 6 hours
and the longest of a week without being related to the CIWA Ar score.
The average duration of treatment with diazepam was 5.5 days (IC 95 = 6.6-3.8), The average
duration of treatment with dexmedetomidine was 3.1 days (95% CI = 4.5-1.7) After applying t
student a significant difference was found in the number of days in favor of dexmedetomidine
(p = 0.0016)
CONCLUSIONS
The investigators found that DEX at conventional doses, for the treatment of moderate-severe
alcohol withdrawal in terms of reducing the CIWA-Ar scale, in fewer days and with fewer
adverse effects and complications.
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