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Withdrawal, Drug, Emergency Medicine

Trevonne M. Thompson Reviewed 06/2017



  • Neuroexcitation is the hallmark of benzodiazepine, barbiturate, and opiate withdrawal

  • Benzodiazepine and barbiturate withdrawal can be life threatening

  • Opiate withdrawal can be extreme...


Signs and Symptoms

  • Benzodiazepines and barbiturates:

    • Anxiety

    • Agitation

    • Irritability

    • Tremor

    • Sleep disturbance

    • Tachycardia

    • Hypertension

    • Hyperthermia

    • Autonomic instability

    • Seizures

  • Opiates:

    • Restlessness

    • Irri...



  • Assess vital signs

  • Assess capillary glucose

Initial Stabilization/Therapy

  • Attention to ABCs

  • Obtain IV access

  • IV fluid administration

  • Cardiopulmonary monitoring

Ed Treatment/Procedures

  • Be...



Admission Criteria

  • Moderate-to-severe withdrawal symptoms

  • Persistent withdrawal symptoms

  • Psychosis with withdrawal

  • Autonomic instability

  • Concomitant medical condition that may complica...

Pearls and Pitfalls

  • Misdiagnosis of medical disease as withdrawal syndrome

  • Misunderstanding the relationship between withdrawal syndromes and comorbid medical illness

  • Important to administer sufficient ...

Additional Reading

  • Hamilton  RJ. Withdrawal principles. In: Nelson  LS, ed. Goldfrank's Toxicologic Emergencies. 9th ed. New York, NY: McGraw-Hill, 2010.

  • Leikin  JB. Substance-related disorders in ad...



292.0 Drug withdrawal 


  • F11.23 Opioid dependence with withdrawal

  • F15.23 Other stimulant dependence with withdrawal

  • F19.239 Oth psychoactive substance dependence with withdrawal, unsp

  • F13.239...

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