Suspected Substance Withdrawal in Adolescents Clinical Pathway — Inpatient

Adolescent with Suspected Substance Withdrawal

This pathway guides the care of adolescents with suspected acute withdrawal from alcohol, benzodiazepines and/or opioids with:

Referral from outside hospitals, psychiatric inpatient units, or crisis response centers for suspected withdrawal
Presence of unprescribed drugs noted during admission, during search of belongings
Disclosed usage
Positive urine drug screen for alcohol, benzodiazepine, or opioid

This pathway does not guide the care of inpatients treated with prolonged courses of benzodiazepines or opioids.

General Signs and Symptoms of Withdrawal

Alcohol/Benzodiazepines	Opioids
Clouded sensorium, disorientation Restlessness, anxiety, agitation Mydriasis Diaphoresis, rhinorrhea Tachycardia, elevated BP Nausea, vomiting, abdominal cramping, diarrhea Headache, seizure, tremor Auditory, visual and/or tactile disturbances	Restlessness, anxiety, agitation Lacrimation, mydriasis Diaphoresis, rhinorrhea Tachycardia, elevated BP Nausea, vomiting, abdominal cramping, diarrhea Tremor, myalgia, arthralgia Tactile disturbances
Note: Withdrawal symptoms may present up to 72 hrs after last use

Toxidromes and Substance Effects

Other Factors to Consider

Iatrogenic benzodiazepine and/or opiate dependency
- Use WAT scoring tool to monitor — Job Aid for WAT Scoring
- PICU Sedation/Analgesia Weaning Pathway
Pregnancy
Toxidrome

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.