Reference

Guide | Reference

108 Substance Intoxication and Withdrawal

Purpose. Ensure substance-related states are identified before primary psychiatric labels. Reduce misattribution in acute presentations.

108.1 Hallmark Signs

Acute onset or rapid fluctuation tied to use patterns.
Autonomic instability, tremor, agitation, sedation, or perceptual changes.
Temporal link to recent initiation, cessation, or dose change.

108.2 High-Risk Contexts

Polysubstance use, recent detox, medically frail patients.
New prescriptions with psychoactive effects.

108.3 Minimum Workup (by setting)

ED/inpatient: vitals, tox screen as appropriate, medication reconciliation. [E0/U2]
Outpatient: structured substance/meds review and safety assessment. [E0/U2]

Red flags

Severe withdrawal risk, delirium tremens, or unstable vitals. [E0/U3]
Psychosis or agitation with unclear substance history. [E0/U3]

Documentation Output. “Substance/withdrawal ruled out vs rule-out required.” Substances considered and temporal relationship noted.