Alcohol withdrawal is caused by the abrupt cessation of alcohol consumption in patients with alcohol dependence or chronic alcoholism.
The clinical presentation consists of a spectrum of signs and symptoms, including autonomic hyperactivity, tremulousness, restlessness, seizures, and potentially life-threatening alcohol withdrawal delirium.
Alcohol withdrawal syndrome is a clinical diagnosis.
Symptom-triggered therapy with benzodiazepines remains the cornerstone of management.
Alcohol withdrawal syndrome (AWS), commonly referred to as "the shakes," occurs in patients with alcohol dependence when their daily alcohol consumption is decreased or stopped. The decrease in blood ethanol below the level at which the patient is habituated triggers AWS. Symptoms typically begin 6-24 hours after the patient's last drink, and may progress to potentially life-threatening alcohol withdrawal delirium (also referred to as delirium tremens), with or without seizures.
History and exam
Key diagnostic factors
- alcohol use
- change in mental status
- hypertension or hypotension
- fever or hypothermia
- hyperglycemia or hypoglycemia
- features of clinical instability
Other diagnostic factors
- nausea and vomiting
- emotional lability
- fine tremor
- history of alcohol withdrawal syndrome (AWS) and alcohol withdrawal delirium
- abrupt withdrawal of alcohol
1st investigations to order
- BUN and serum creatinine
- ethanol concentration
- electrolyte panel
Investigations to consider
- CT of head
- chest x-ray
- electroencephalogram (EEG)
- blood-borne virus screen
- Sympathomimetic toxicity
- The ASAM clinical practice guideline on alcohol withdrawal management
- Assessment and management of alcohol dependence and withdrawal in the acute hospital
Alcohol withdrawalMore Patient leaflets
Alcohol Consumption Screening AUDIT QuestionnaireMore Calculators
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