I was sitting in my office finishing my medical records (which is painful enough) when I realized that I could barely move my arms. It felt like I had been lifting weights. But then I remember that I had not been lifting weights but I had been trying to restrain a patient (along with four nurses) who was going throught bad alcohol withdrawal.
It is always the same scenario. For some reason the patient with alcoholism loses access to the beverage of choice and day or two later goes into the withdrawal. In severe cases it could be life-threatening. Some patients could even have seizures.

I am always amazed how strong the patients with Delirium Tremens (DT) could get. We often end calling security just to pin the patient down. The patient from this morning was, actually, a female weighing no more that 70 kilograms, yet it took five of us to contain her.

Sedating patients going through DTs could be challenging as well. I ended up asking for multiple doses of intravenous Ativan and, yet, after giving 16mg with no effect on the patient’s agitation, I “gave up” and ordered the Precedex drip.

It worked like a charm.

Precedex is a newer sedative medication, primarily used in anesthesiology for cardiac surgery patients. The mechanism of action is via centrally (in the brain) located alpha receptors. This is similar to how Clonidine (blood pressure medicine) works, which makes it even more suitable for alcohol withdrawal.

Even, though, expensive and approved only for a short term use (24 hours), there is a study showing that Precedex could be used safely for longer periods of time. The same study also showed that using Precedex vs. Versed for sedation could be cost-effective.

The most common side effect of Precedex is mild hypotension. This too makes it a good candidate for patients with DTs since most of them are hypertensive.

More studies are needed to expand the spectrum of indications for this medication, yet, I bet you we are going to see it more and more in the ICU practice.

I have an idea how to save billions of dollars in healthcare costs. Start serving alcohol to selected patients while they are being treated in the hospital. I am being absolutely serious. Every day I am seeing patients developing complications from alcohol withdrawal. Usually, the patient is admitted for a scheduled or an urgent surgery. Many patients tend to understate their level of drinking, and on a day 2 – 3 after the admission they go into an alcohol withdrawal. Alcohol withdrawal is not a mere inconvenience. It could be quite severe. Many patients end up being admitted to an Intensive Care Unit. Some patients could even have seizures. Going into an alcohol withdrawal will significantly prolong the hospitalization and will increase the cost tremendously. I figured, that if I am taking care of at least one patient a day, on a national level it will add up to billions of dollars.

You might ask: “So, now we are going to have drunk patients in the hospital?” Well, yes. For many patients who drink alcohol on a daily basis, this becomes a “requirement” for a normal functioning. Some people could even be productive while being…you guessed it – drunk. Alcohol withdrawal, in contrast, could be a severe or even lethal condition. I saw people trying to jump out of the window while going through Delirium Tremens (DT). It is not unusual to require five or six people to hold a patient in DTs down while a sedating medication is being administered. Sometimes, despite an industrial dose of sedatives, we have to put the patient on a ventilator and administer sedation via a continuous infusion. So, to answer your question, I would rather have a “drunk” patient than a patient going through DTs.

Not all the patients should be offered alcohol while in the hospital. It should only be given by a physician order, just like any other medicine. Careful screening and thorough examination will be performed by an admitting physician before the “need” for alcohol is determined.

The concept of “prescribing” alcohol in the hospital is not new. In some places it is still being done. I once asked an older Dietitian about it. The answer that I got was quite surprising. Apparently, we used to give patients alcohol, but stopped doing it. Guess what was the reason? Not what you might think…we just didn’t have a good variety of beverages to suite every taste.