Alcohol Father-in-law lost in AWS, Can I help him?

[ouchy]

First, I would like to say that I am pretty well versed in general medical terms etc, so if any of you guys have to speak technically please do. We are going crazy and need ideas, help, something. I came here because I need to hear experienced opinions.

My father-in-law, 71, severe alcoholic, walked into an ER 13 days ago with shortness of breath. He already has severe COPD, but discovered he had bilateral blot clots and of course needed admission. Upon admission he was already suffering from Alcohol Withdrawal. I specifically asked for ativan for his stabilizing drug. They used it with no problem. His condition deteriorated and they weren't doing much to help. I am not a hospital basher but this got totally out of hand.

At some point we realized that they were not treating symptomatic lung conditions but their focus had turned to withdrawal. This is not what we wanted (yes, we like him dry but one thing at a time please). He has mild dementia, but is fully functional at home with ZERO assistance for anything except driving and complicated paperwork (I think the latter was laziness). When he is in the hospital the dementia mixes with AWS and causes a perfect storm. We wanted him home if the medical end was stable.

We had to force their hand to get him home but he is an invalid and even non responsive at times. His DTs seemed to have passed some 48 hours ago, at least as far as we can tell. I don't understand where we are now. His labs were done and I am assuming that I am getting the full truth when Magnesium and Vitamin K were the only labs down. Thyroid function is abnormal but no emergency flags were thrown up.

Thanks

 

[cj]

What are his symptoms? I guess the best way to find out if withdrawal is causing whatever problem is to either load em up with benzos or get him drunk.

 

[ouchy]

Would love to give him a shot of whiskey to see if he could regain. I am just afraid of the other symptoms.

Symptoms: Excessive sleepiness. When awake slow to respond if respond at all. Speech is dysfunctional (quiet, malformed words). Gazing, delusions, crying. Muscle weakness (could be worse from hospital stay). Not independent in ANYTHING.

 

[smackydowners]

is he still on the ativan? it could be the cause of the sleepiness and weakness and speech.

if not, he could easily still be in DT's. if his alcoholism was really severe, it could take quite some time for him to get better.

if he is actually going to stay dry i wouldn't recommend giving him alcohol now just to see if this cures his symptoms, i'd just concentrate on nursing him back to health in this recuperation phase.

 

[ouchy]

is he still on the ativan? it could be the cause of the sleepiness and weakness and speech.

if not, he could easily still be in DT's. if his alcoholism was really severe, it could take quite some time for him to get better.

if he is actually going to stay dry i wouldn't recommend giving him alcohol now just to see if this cures his symptoms, i'd just concentrate on nursing him back to health in this recuperation phase.

No, not on Ativan for about 48 hours give or take. In a perfect world he would be dry, but that really isn't reality. He has been an alcoholic for over 50 years and drank some as a child. That notwithstanding I still don't WANT to give him alcohol. All I want is to see him in there somewhere. To be sick with other things and having withdrawal is so bad.

It is severe alcoholism. Not a lightweight on it, in any respects. How he has good organs is beyond me. So, you think he could still be in DTs? After 13 days? What would you think would be a window of seeing it clear?

He has been through seeing things etc, he is more the sleeping man now. I hate to see him so disassociated as well. I am just trying to keep him hydrated and range of motion good.

 

[cj]

Yeah man he is still in DTs. From the mental symptoms you describe my number 1 fear is that he had a stroke. Has that been ruled out?

 

[smackydowners]

if he was drinking a lot then this sounds quite dangerous. isn't he a shaking, sweating, anxious wreck? if he is, he might need more medication to steadily bring him down.

suddenly stopping drinking after 50 years of daily alcohol abuse can cause seizures, comas, psychosis and other nasty things.

the ativan would be helping; has he only been like this since stopping the ativan? how much was he drinking? i'd maybe take him back to hospital depending on the severity of his symptoms.

 

[Keif' Richards]

Alcohol withdrawal isn't something that should ever be undertaken without the assistance of an MD, either in a hospital or through otherwise close-monitoring of the patient. Many still elect to go through the process on their own due to factors ranging from physical/social embarassment/fear of medical facilities including offices and hospitals/all the way down to alcohol induced foolishness and false-pride.

What is the level of alcohol intake, what's his liver function like (that you know of), what are the notes from the attending physician who saw the patient? The information will help make a somewhat educated guess as to the severity of his withdrawal, but there's really no excuse for proper medical care. If you're not getting the help you need at the hospital you already visited, go to another one. If this isn't possible, return to the original facility and cross swords with the hospitallist or chief of emergency medicine. I'm not saying you don't understand, but delirium tremens is different from alcohol withdrawal. When DT's begin, there's a ~15% - ~40% increased risk of acute fatality, so any doctor worth his weight in shit would be able to clearly identify symptoms like soaring hypertension, extreme delirium w/ possible loss of consciousness and irregular heart rhythms.

I hope this all works out for your father-in-law.

 

[mike.vick]

Baclofen treats alcohol DT's!!! Any MD would willing write a 90 day supply for $10

Baclofen, Baclofen, Baclofen -- you could have it 2 hours from now if you go to a walk-in med clinic

Almost no side-effects and will not get him intoxicated itself. It works on GABA-B to cease DT's and the craziness. Although you will be slowly titrated off this if you so choose to quit.

 

[Keif' Richards]

I agree that baclofen is useful in treating acute and chronic alcoholism, but I can say from experience that it is not sufficient in its own right. A sedative (benzodiazepine) regimen/taper is going to be required to withdraw the patient safely and in relative comfort.

That said, there are myriad other medicines that can be used in conjunction with the sedative taper.

 

[ouchy]

Thank you so much for the replies! It is has been very helpful.

Actually, the answers to some of the questions asked are yes and no on the Ativan. He had a lot of the symptoms during the admin of the Ativan too. But from the responses I am betting his is definitely in DTs (that and the delusions have returned)
Yes, we have medical support but it is a little slower than inpatient. We have a team working with him, monitoring at home because his mild dementia turns into hospital psychosis. We want his at home if possible. BUT we are monitoring very closely to have him moved immediately should a vital emergency arrive. This isn't the first very sick person I have cared for. I would not refuse him proper medical treatment.

I have asked for the Ativan to be prescribed again for us to have a maintenance drug. He actually has Baclofen on hand because of a neck injury, so you can bet he is getting that right away.

The inpatient notes were more of agitation and his breathing issues (COPD) but all labs are good. Vitals still good, in fact better than a healthy person. No shaking, no sweating, no rapid heartbeat, no elevated temp, no high blood pressure.

Thank you!

 

[PriestTheyCalledHim]

Have him go to a different hospital or see different doctors if you are not pleased with the care he is getting, or they're not taking his alcohol withdrawal seriously as it should be taken. Can you get him into a detox/rehab run by medical professionals? Good luck.