Alcohol withdrawal requiring massive prolonged benzodiazepine infusion

The objective of this case report is to describe a patient with prolonged alcohol withdrawal requiring massive standing doses of benzodiazepines. The setting is the medical intensive care unit of the Tripler Army Medical Center, Honolulu, Hawaii. The patient is a 58-year-old alcohol-dependent male presenting with mental status changes and agitation following an uncomplicated cystoprostatectomy, who ultimately required massive doses of benzodiazepines to treat his symptoms effectively. We conclude that symptom-triggered therapy proved ineffective in this case due to inability to achieve adequate frequency of assessments. Ultimately, a lengthy, high-dose, fixed interval benzodiazepine regimen was required. The 5-week period of intensive care illustrated that scheduled doses of benzodiazepines may be required and massive and prolonged doses are sometimes necessary. Adherence to a slow-weaning protocol understood by an interdisciplinary team was critical to this patient's recovery. Additionally, toxicity from the high-dose medication was not observed.