What monitoring protocols should be implemented for a patient at risk of developing delirium tremens during alcohol withdrawal?

Monitoring protocols for a patient at risk of developing delirium tremens during alcohol withdrawal should include:

• Admission to hospital for medically assisted alcohol withdrawal if the patient is at high risk of delirium tremens, to allow for close monitoring and management in a setting with 24-hour assessment availability.
• Use of a symptom-triggered regimen for drug treatment, where medication is adjusted based on the severity of withdrawal symptoms, requiring frequent and competent monitoring by healthcare staff.
• Regular assessment and monitoring of withdrawal symptoms using validated tools such as the Clinical Institute Withdrawal Assessment – Alcohol, revised (CIWA–Ar) scale, as an adjunct to clinical judgement.
• Immediate assessment on admission by healthcare professionals skilled in managing alcohol withdrawal.
• Review and adjustment of the withdrawal drug regimen promptly if delirium tremens develops during treatment.
• Provision of oral lorazepam as first-line treatment for delirium tremens, with parenteral lorazepam or haloperidol if oral medication is declined or symptoms persist.
• Consideration of patient-specific factors such as decompensated liver disease, malnourishment, or other vulnerabilities that may require tailored monitoring and management.

These protocols ensure early detection and effective management of delirium tremens, reducing morbidity and mortality associated with severe alcohol withdrawal.

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