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ALCOHOL DETOX
PROTOCOL
DATE: _________________ DIAGNOSIS: Acute Alcohol Intoxication
ADMIT TO: Medical Unit CCU Primary CCU Secondary Psychiatry
ATTENDING PHYSICIAN: _________________________________________
ALLERGIES:
____________________________________________________________________________________________________ ACTIVITIES:
អ Bedrest អ Bedrest with Commode អ BRP with assistance អ Up ad lib DIET: ____________________________________________________________________________________________________________
អ Other: ______________________________________________________________________________________ VITAL SIGNS:
អ Every four hours អ Every eight hours Monitor every four to eight hours with CIWA-Ar until score is less than ten for 24 hours; additional assessments as
needed; monitor closely following medications

MEDICATION FOR WITHDRAWAL PREVENTION (choose one of the following)
អ Chlordiazepoxide (Librium) PO 50 mg every six hours for four doses, then 25 mg every six hours for eight doses OR
អ Diazepam (Valium) PO 10 mg every six hours for four doses, then five milligrams every six hours for eight doses OR
អ Lorazepam (Ativan) PO two milligrams every six hours for four doses, then one milligram every six hours for eight doses MEDICATION FOR WITHDRAWAL TREATMENT (when CIWA-Ar is equal to or greater than 10: choose one of the following)
អ Chlordiazepoxide (Librium) PO 50 to 100 mg every hour OR
អ Diazepam (Valium) PO 10 - 20 mg every hour OR
អ Lorazepam (Ativan) Pot three to six milligrams every hour MEDICATIONS PRN FOR AGITATION, HALLUCINATIONS, OR IF UNRESPONSIVE TO ORAL TREATMENT (requires close
monitoring and equipment and ability to start respiratory support immediately if needed; choose one of the following)

អ Haloperidol (Haldol) IM/IV two to five milligrams OR
អ Haloperidol IM/IV two to five milligrams with Lorazepam (Ativan) IV/IM two to four milligrams OR
អ Diazepam (Valium) IM/IV five milligram slowly, may repeat once after five minutes; if insufficient response, increase to 10 mg every five minutes for two doses; if still insufficient response, increase to 20 mg every five minutes OTHER MEDICATIONS:
Thiamine 100 mg IV/IM time one dose, then 100 mg PO dailyFolic Acid one milligram PO daily OTHER ORDERS: (cross out any unused lines)
________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Physician Signature: ____________________________________________________ Date/Time: ______________________________ ALCOHOL DETOX ORDERS
ALCOHOL DETOX
PROTOCOL
DATE: _________________ DIAGNOSIS: Acute Alcohol Intoxication
ADMIT TO: Medical Unit CCU Primary CCU Secondary Psychiatry
ATTENDING PHYSICIAN: _________________________________________
ALLERGIES:
____________________________________________________________________________________________________ ACTIVITIES:
អ Bedrest អ Bedrest with Commode អ BRP with assistance អ Up ad lib DIET: ____________________________________________________________________________________________________________
អ Other: ______________________________________________________________________________________ VITAL SIGNS:
អ Every four hours អ Every eight hours Monitor every four to eight hours with CIWA-Ar until score is less than ten for 24 hours; additional assessments as
needed; monitor closely following medications

MEDICATION FOR WITHDRAWAL PREVENTION (choose one of the following)
អ Chlordiazepoxide (Librium) PO 50 mg every six hours for four doses, then 25 mg every six hours for eight doses OR
អ Diazepam (Valium) PO 10 mg every six hours for four doses, then five milligrams every six hours for eight doses OR
អ Lorazepam (Ativan) PO two milligrams every six hours for four doses, then one milligram every six hours for eight doses MEDICATION FOR WITHDRAWAL TREATMENT (when CIWA-Ar is equal to or greater than 10: choose one of the following)
អ Chlordiazepoxide (Librium) PO 50 to 100 mg every hour OR
អ Diazepam (Valium) PO 10 - 20 mg every hour OR
អ Lorazepam (Ativan) Pot three to six milligrams every hour MEDICATIONS PRN FOR AGITATION, HALLUCINATIONS, OR IF UNRESPONSIVE TO ORAL TREATMENT (requires close
monitoring and equipment and ability to start respiratory support immediately if needed; choose one of the following)

អ Haloperidol (Haldol) IM/IV two to five milligrams OR
អ Haloperidol IM/IV two to five milligrams with Lorazepam (Ativan) IV/IM two to four milligrams OR
អ Diazepam (Valium) IM/IV five milligram slowly, may repeat once after five minutes; if insufficient response, increase to 10 mg every five minutes for two doses; if still insufficient response, increase to 20 mg every five minutes OTHER MEDICATIONS:
Thiamine 100 mg IV/IM time one dose, then 100 mg PO dailyFolic Acid one milligram PO daily OTHER ORDERS: (cross out any unused lines)
________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Physician Signature: ____________________________________________________ Date/Time: ______________________________ ALCOHOL DETOX ORDERS

Source: http://usmlemd.files.wordpress.com/2010/06/alcohol-detox-protocol.pdf

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