Consider giving 2mg of lorazepam to your patient who’s back at baseline after one alcohol withdrawal seizure to possibly prevent recurrent seizures. This may even save you an admission as long as the patient has been at baseline without signs or symptoms of alcohol withdrawal for at least 6 hours.
D’Onofrio et al. performed a randomized, double-blind study over a 21 month period comparing lorazepam to placebo (normal saline) for the prevention of recurrent alcohol related seizures. Patients who had sustained an alcohol withdrawal seizure but now back at baseline randomly received 2 mg of lorazepam and 2 ml of NS (case) versus 4ml of NS (control) and were observed for 6 hrs. 3/100 (3%) case patients had a second seizure compared to 21/86 (24%) control patients (p<0.001). 29% of lorazepam patients were admitted to the hospital versus 42% of placebo patients (p=0.02). Treatment with lorazepam was associated with a significant reduction in recurrent alcohol withdrawal seizures.
D’Onofrio G, Rathlev NK, Ulrich AS, Fish SS, Freedland ES. Lorazepam for the prevention of recurrent seizures related to alcohol. N Engl J Med. 1999 Mar 25;340(12):915-9.
