Alcohol withdrawal

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources

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Last reviewed: 12 Aug 2025
Last updated: 10 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • alcohol use
  • change in mental status
  • hallucinations
  • seizures
  • delusions
  • hypertension or hypotension
  • fever or hypothermia
  • hyperglycemia or hypoglycemia
  • features of clinical instability
Full details

Other diagnostic factors

  • tremor
  • nausea and vomiting
  • anorexia
  • anxiety/restlessness
  • emotional lability
  • insomnia
  • irritability
  • diaphoresis
  • headache
  • fine tremor
  • agitation
  • tachycardia
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • BUN and serum creatinine
  • LFTs
  • ethanol concentration
  • electrolyte panel
  • CBC
Full details

Tests to consider

  • CT of head
  • chest x-ray
  • electroencephalogram (EEG)
  • blood-borne virus screen
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Expert advisers

Hong K. Kim, MD, MPH

Associate Professor

Department of Emergency Medicine

University of Maryland School of Medicine

Baltimore

MD

Disclosures

HKK declares that he has no competing interests.

Nicholas J. Connors, MD

Program Director

HCA Healthcare/Mercer University/Trident Medical Center

Emergency Medicine Residency Program

Charleston

SC

Disclosures

NJC declares that he has no competing interests.

Peer reviewers

Kinjal Sethuraman, MD, MPH

Associate Director

International Emergency Medicine

Long Island Jewish Hospital

New York

NY

Disclosures

KS declares that he has no competing interests.

Paul S. Haber, MD

Royal Prince Alfred Hospital and Discipline of Medicine

The University of Sydney

Sydney

Australia

Disclosures

PSH is an author of a reference cited in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Bayard M, McIntyre J, Hill KR, et al. Alcohol withdrawal syndrome. Am Fam Physician. 2004 Mar 15;69(6):1443-50.Full text  Abstract

American Society of Addiction Medicine. The ASAM clinical practice guideline on alcohol withdrawal management. J Addict Med. 2020 May/Jun;14(3s suppl 1):1-72.Full text  Abstract

Bråthen G, Ben-Menachem E, Brodtkorb E, et al. Chapter 29: alcohol-related seizures. EFNS guidelines of alcohol-related seizures. In: Gilhus NE, Barnes MP, Brainin M, eds. European handbook of neurological management. 2nd ed, v1. Oxford, UK: Blackwell Publishing; 2011:429-36.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Text revision. (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Sympathomimetic toxicity
    • Encephalitis
    • Meningitis
    More Differentials

  • Guidelines

    • The ASAM clinical practice guideline on alcohol withdrawal management
    • Assessment and management of alcohol dependence and withdrawal in the acute hospital
    More Guidelines

  • Calculators

    Alcohol Consumption Screening AUDIT Questionnaire

    More Calculators

  • Patient information

    Alcohol withdrawal

    More Patient information
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