Fluid balance must be maintained, and large doses of vitamin C and B-complex vitamins, particularly thiamine, must be given promptly. All patients entering withdrawal are candidates for CNS-depressant drugs, but not all need them. Many patients can be detoxified without drugs if proper attention is paid to psychologic support and reassurance and if the approach and environment are nonthreatening. However, these methods may not be possible in general hospitals or emergency departments. Benzodiazepines are the mainstay of therapy.
Dosage depends on vital signs and mental status.
Routine administration of phenytoin is not necessary. Outpatient therapy with phenytoin is almost always a waste of time and drug, because seizures occur only under the stress of alcohol withdrawal and patients who are withdrawing or heavily drinking do not take their anticonvulsants. First, alcohol is withdrawn. Maintaining sobriety is difficult. The patient should be warned that after a few weeks, when he has recovered from his last bout, he is likely to find an excuse to drink.