An ethanol protocol to prevent alcohol withdrawal syndrome

J Am Coll Surg. 2006 Aug;203(2):186-91. doi: 10.1016/j.jamcollsurg.2006.04.025. Epub 2006 Jun 22.


Background: Alcohol withdrawal syndrome (AWS) occurs in dependent patients during the initial period of sudden onset abstinence. It is usually manifested by mild symptoms such as disorientation, agitation, and tachycardia, but, if untreated, can lead to severe confusion, seizures, and even cardiovascular collapse. Prevention of AWS has been shown to improve morbidity and mortality and shorten hospital and ICU stays. We examined the efficacy of ethanol as a method of prophylaxis.

Study design: Our patient population was divided into two groups. Group 1 consisted of surgical patients receiving alcohol prophylaxis for AWS between January 2001 and July 2004 (n=124), as identified by retrospective chart review. We then developed a protocol for the initiation, dosage, and weaning of intravenous ethanol in patients at risk for AWS, based on blood alcohol levels and clinical assessment of withdrawal symptoms and signs. Group 2 consisted of all patients treated prospectively with this protocol during the subsequent year (n=76). Patients who did not fit inclusion criteria for the protocol were excluded from analysis, resulting in 92 and 68 patients in group 1 and group 2, respectively. We compared initiation criteria, efficacy, dosage, route, duration, and referral pattern to the substance abuse clinic before and after initiation of the protocol.

Results: Our initial use of intravenous ethanol was very variable in dosage, duration, and indication. The protocol decreased the duration of treatment between the two groups from 7 days to a mean of 3 days. The failure rate dropped from 20% to 7%. Referral to the substance abuse clinic rose from 7.6% to 20%. The only complication was asymptomatic hyponatremia in one patient.

Conclusions: Intravenous ethanol is a viable option for AWS prophylaxis when administered in a systematic protocol.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Alcoholism / rehabilitation*
  • Central Nervous System Depressants / administration & dosage
  • Central Nervous System Depressants / adverse effects
  • Central Nervous System Depressants / therapeutic use*
  • Dose-Response Relationship, Drug
  • Ethanol / administration & dosage
  • Ethanol / adverse effects
  • Ethanol / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Prospective Studies
  • Substance Withdrawal Syndrome / prevention & control*
  • Treatment Outcome


  • Central Nervous System Depressants
  • Ethanol