How do you evaluate and manage acute alcohol withdrawal when symptom-driven protocols are confounded/unreliable?

Often, if someone has an underlying condition that may artifactually elevate their symptom monitor scores (such as essential tremor in CIWA-Ar or tachycardia from cancer or sepsis in mMINDS), I will do any of the following:

1. Increase the threshold for the symptom-triggered med by a few points (if th...

Scheduled benzodiazepine-taper OR phenobarbital.

Librium 50 TID

Librium 50 BID

Librium 50 qam and can discharge them unless they’re getting PRN.

I don’t do CIWA since it’s so subjective, but just have staff take vitals q4h and if BP systolic above 160 or heart rate above 115 then PRN. The best way to not have breakthrough seizures and avoid drug s...