====== Acute Management of Alcohol Problems ======

===== GENERAL =====

Patients with an alcohol problem do not need to be admitted for that reason alone. Only those who are sick or in severe withdrawal need the services of a general hospital and the others can be managed elsewhere after an adequate assessment.

===== INTOXICATED PATIENTS =====

Assess the level of intoxication, the presence or absence of medical illness, and the patient's home situation and stated desires.

==== Blood alcohol concentration (BAL) ====

**//Conversion factor// **

   * g/L x 21.7 = mmol/L
  * mmol/L x 0.046 = g/L

Use the breathalyser to estimate BAL. The patient should be kept in the Emergency Department at least until the concentration falls below 0.2 g%. Withdrawal may begin at a BAL of 0.1 g% and will usually have begun before the concentration reaches zero.

==== Medical assessment ====

Perform a medical assessment including respiratory function. If the patient requires admission on medical grounds, observe for withdrawal.

==== Proclaimed place ====

If the home situation seems inadequate refer to an alternative safe environment such as a "Proclaimed Place". A proclaimed place in New South Wales is a facility usually operated by a non-government organisation such as the Salvation Army which provides a safe environment for intoxicated people to sober up. They are usually staffed by volunteers and offer overnight accommodation only.

==== Detoxification ====

If the patient expresses interest in alcohol rehabilitation, refer to a detoxification unit. Detoxification units are not hospital wards, and although they may include nurses amongst their staff, do not provide medication or the routine clinical observations which would be expected in a hospital.

===== PATIENTS IN ALCOHOL WITHDRAWAL =====

Patients in [[:wikitox:2.1.11.5.2_alcohol_withdrawal|alcohol withdrawal]] should not require hospital admission unless complicated or suffering from an intercurrent illness.

==== Assess the severity of withdrawal ====

If already complicated by [[:wikitox:3.2.1.1.5_hallucinations|hallucinations]] or confusion, admit and treat appropriately. If the patient has suffered a withdrawal seizure but appears to have recovered fully, give [[:wikitox:benzodiazepines|diazepam]] according to the protocol, and observe for four (4) hours in Emergency before discharge or referral. Similarly, if the patient is scoring > 15 on the [[:wikitox:alcohol_withdrawal_scale|alcohol withdrawal scale]], treat according to the protocol until the score is below 15 before discharge.

==== Assess medically ====

Perform a medical assessment and admit or [[:wikitox:2.1.11.5.2_alcohol_withdrawal|treat as indicated]].

==== Discharge ====

If fit for discharge or referral, the patient can go home and detoxify there if there are other family members available to provide support, and the family doctor can be contacted and asked to review the situation within 24 hours. Otherwise, refer to a detoxification unit.