Comparison of the Effectiveness between Symptom-Triggered Regimen and Intravenous Loading Diazepam Regimen for Alcohol Withdrawal In-Patients in a Community Hospital, Dan Khun Thot District, Nakhon Ratchasima Province

Abstract

Alcohol withdrawal with severe symptoms can lead to hospitalization. It also presents complications among patients with alcohol dependence while hospitalized with other diseases, such as delirium or psychosis. The regular treatment plan aims to promptly alleviate patients' symptoms without complications. Therefore, this retrospective observational study aimed to compare the effectiveness of treating severe alcohol withdrawal symptoms with Benzodiazepine between a symptom-triggered regimen and an intravenous loading Diazepam regimen among 136 patients with alcohol dependence (ICD 10: F1030/F1031). The AWS (Alcohol Withdrawal Scale) score 15 was used to diagnose in-patients admitted to the male ward at Dan Khun Thot Hospital, Nakhon Ratchasima Province, between October 1, 2017, and December 31, 2021. The participants were divided into two groups: the first group received the symptom-triggered regimen, while the second group received the intravenous loading Diazepam regimen. A total of 136 participants were diagnosed with alcohol withdrawal, with 66 participants receiving the symptom-triggered regimen (group 1) and 70 participants receiving the intravenous loading Diazepam regimen (group 2). The median length of time (hours) for participants with AWS score 15 in both groups was 40 and 28 hours, respectively (p=0.002). The mean AWS score during hospitalization was 13.5 ± 2.68 for group 1 and 12.5 ± 2.34 for group 2, respectively (p=0.029). The AWS scores for symptoms such as perspiration, anxiety, and agitation revealed that the AWS score of group 2 after receiving the treatment was significantly lower than that of group 1 (p < 0.05). Regarding complications, psychosis occurred only in group 1, affecting approximately 7.6% of patients (p=0.025), while sleep apnea did not emerge in either group. Moreover, the dose of Benzodiazepine used to treat the symptoms showed that the dose equivalent effect to Diazepam in group 1 and group 2 was 287.5 mg and 400 mg, respectively (p < 0.001). In conclusion, the treatment of alcohol withdrawal using the intravenous loading Diazepam regimen reduced the severity of alcohol withdrawal with severe symptoms more rapidly than the symptom-triggered regimen. Additionally, it decreased perspiration, anxiety, and agitation. Furthermore, there were no instances of sleep apnea as a treatment-related complication.