Alcohol withdrawal

Last reviewed: 2 Nov 2022
Last updated: 21 Jun 2022

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
  • alcohol withdrawal delirium
  • agitation
  • coarse tremor
  • hypertension or hypotension
  • fever or hypothermia
Full details

Other diagnostic factors

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

Risk factors

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

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

ACUTE

suspected alcohol withdrawal and CIWA-Ar score ≥10 or GMAWS score ≥2

suspected alcohol withdrawal and CIWA-Ar score <10 or GMAWS score <2

Contributors

Expert advisers

Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC, RCSEd

Emergency Medicine Consultant

Barts Health NHS Trust

Physician Response Unit Consultant

London’s Air Ambulance

Royal London Hospital

London

UK

Disclosures

AA declares that he has no competing interests.

Thomas King

Disclosures

TK declares that he has no competing interests.

Acknowledgements

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

Peer reviewers

Nigel Langford

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.

Editors

Annabel Sidwell

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Tannaz Aliabadi-Oglesby

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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  • Guidelines

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  • Videos

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  • Patient leaflets

    Alcohol withdrawal

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