Alcohol withdrawal

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.[1]Bayard M, McIntyre J, Hill KR, et al. Alcohol withdrawal syndrome. Am Fam Physician. 2004 Mar 15;69(6):1443-50. https://www.aafp.org/afp/2004/0315/p1443.html http://www.ncbi.nlm.nih.gov/pubmed/15053409?tool=bestpractice.com [2]Parker AJ, Marshall EJ, Ball DM. Diagnosis and management of alcohol use disorders. BMJ. 2008 Mar 1;336(7642):496-501. https://www.doi.org/10.1136/bmj.39483.457708.80 http://www.ncbi.nlm.nih.gov/pubmed/18310004?tool=bestpractice.com [3]Stewart S, Swain S, NICE; Royal College of Physicians, London. Assessment and management of alcohol dependence and withdrawal in the acute hospital: concise guidance. Clin Med (Lond). 2012 Jun;12(3):266-71. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953492 http://www.ncbi.nlm.nih.gov/pubmed/22783781?tool=bestpractice.com [4]Hall W, Zador D. The alcohol withdrawal syndrome. Lancet. 1997 Jun 28;349(9069):1897-900. http://www.ncbi.nlm.nih.gov/pubmed/9217770?tool=bestpractice.com [5]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. https://www.doi.org/10.1097/ADM.0000000000000668 http://www.ncbi.nlm.nih.gov/pubmed/32511109?tool=bestpractice.com [6]Tiglao SM, Meisenheimer ES, Oh RC. Alcohol withdrawal syndrome: outpatient management. Am Fam Physician. 2021 Sep 1;104(3):253-62. https://www.aafp.org/pubs/afp/issues/2021/0900/p253.html http://www.ncbi.nlm.nih.gov/pubmed/34523874?tool=bestpractice.com