At the first appointment, it is recommended that you obtain some baseline observations and blood tests. This should include full blood count, urea and electrolytes, liver function, iron studies, glucose, calcium, magnesium and phosphate.
Screen patients with the following questionnaires:
• Alcohol Use Disorders Identification Test (https://patient.info/doctor/alcohol-usedisorders-identification-test-audit)
• Severity of Alcohol Dependence Questionnaire (http://php.nhs.uk/wp-content/uploads/ sites/26/2013/11/SADQ.pdf)
• Kessler Psychological Distress Scale (https://www.tac.vic.gov.au/files-to-move/ media/upload/k10_english.pdf).
To save time, the patient can take these questionnaires home and bring them back to their follow-up appointment. If you are considering a medicated detox, guidelines suggest starting the patient on oral thiamine 200 mg for two weeks before starting the detox. This reduces the risk of Wernicke’s encephalopathy. For low-risk continuing drinkers 100 mg thiamine daily is generally enough.
Diazepam can be used in a weaning regimen (Table) over several days to reduce the risk of seizures and withdrawal syndrome and to ease alcohol cravings. Oxazepam is a safer alternative if the patient has concurrent liver impairment, as it does not require hepatic oxidation.
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