Last reviewed: 1 Nov 2020
Last updated: 11 Feb 2020

Summary

Definition

History and exam

Key diagnostic factors

  • risk factors
  • alcohol dependence
  • cessation or reduction in alcohol intake
  • at least one feature of alcohol withdrawal
  • seizures 
  • delirium tremens
  • psychiatric disturbance
  • coarse tremor
  • hypertension or hypotension
  • fever or hypothermia

Other diagnostic factors

  • anxiety 
  • nausea and vomiting
  • autonomic dysfunction
  • insomnia 
  • craving for alcohol
  • headache 
  • anorexia 
  • depression 

Risk factors

  • history of alcohol withdrawal syndrome (AWS) and delirium tremens
  • abrupt withdrawal of alcohol

Diagnostic investigations

1st investigations to order

  • venous blood gas
  • blood glucose
  • full blood count
  • urea and electrolytes
  • liver function tests
  • bone profile
  • coagulation studies
Full details

Investigations to consider

  • blood cultures
  • CT head
  • Chest x-ray
  • ECG
  • amylase/lipase
  • ammonia
  • lumbar puncture
  • electroencephalography (EEG)
  • blood-borne virus screen
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

Flight Doctor 

Greater Sydney Area Helicopter Emergency Medical Service

Sydney

New South Wales

Australia

Disclosures

AA declares that he has no competing interests.

Disclosures

TK declares that he has no competing interests.

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Hong K. Kim MD, MPH

Assistant Professor

Department of Emergency Medicine

University of Maryland School of Medicine

Baltimore

MD

Nicholas J. Connors MD

Associate Professor

Department of Emergency Medicine

Medical University of South Carolina

Charleston

SC 

Disclosures

HKK and NJC declare that they have no competing interests.

Peer reviewersVIEW ALL

Consultant Acute/General Medicine

University Hospitals of Leicester NHS Trust

Honorary Senior Lecturer

Department of Medical Education

University of Leicester

Leicester

UK

Disclosures

NL has worked as an clinical pharmacologist expert witness at criminal, civil, family, and coroner's courts; given lectures on alcohol withdrawal at undergraduate and postgraduate events; published various articles and written book chapters.

Section Editor, BMJ Best Practice 

Disclosures

AS declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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