2025 Multiprofessional Critical Care Review: Adult Online-3: Management of Drug Withdrawal Syndromes in the ICU

Video Transcription

Video Summary

In this video, Dr. Saurabh Patel discusses the management of various withdrawal syndromes in the intensive care unit (ICU). He covers the management of alcohol withdrawal, opioid withdrawal, stimulant withdrawal, and THC (cannabinoid) withdrawal. <br /><br />For alcohol withdrawal, Dr. Patel explains that the mechanism of action involves GABA receptor hyperactivity. He discusses the diagnostic criteria for alcohol withdrawal and the use of supportive therapies such as patient hydration and essential electrolyte replacement. He also mentions therapeutic options including medications that act on the GABA receptor, such as barbiturates and benzodiazepines.<br /><br />Regarding opioid withdrawal, Dr. Patel discusses the importance of accurately identifying the substance involved to determine the appropriate management strategies. He mentions the use of alpha-2 agonists, gabapentinoids, and slowly titrating methadone. He also mentions the utilization of diphenoxylate for severe diarrhea.<br /><br />Dr. Patel then explains the management of stimulant withdrawal, including the use of benzodiazepines for acute and severe agitation, hydration, and the management of hypertensive episodes. He mentions adjunct therapies like methylphenidate and engaging the substance abuse and addiction teams for safe outpatient transition.<br /><br />Lastly, Dr. Patel discusses the management of THC withdrawal, including the use of noradrenergic agents, serotonergic agents, and the possibility of using CB1 receptor agonists like dronabinol. He emphasizes the importance of tapering and monitoring the patient during treatment and discontinuing therapy as deemed safe.<br /><br />Overall, the video provides an overview of the management approaches for various withdrawal syndromes in the ICU, highlighting important considerations and therapies for each.

Keywords

withdrawal management

ICU

alcohol withdrawal

opioid withdrawal

stimulant withdrawal

THC withdrawal

Dr. Saurabh Patel

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