Alcohol withdrawal

Last reviewed: 28 Aug 2022
Last updated: 05 Jul 2022

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
More key diagnostic factors

Other diagnostic factors

  • tremor
  • nausea and vomiting
  • anorexia
  • anxiety/restlessness
  • emotional lability
  • insomnia
  • irritability
  • diaphoresis
  • headache
  • fine tremor
  • agitation
  • tachycardia
Other diagnostic factors

Risk factors

  • history of alcohol withdrawal syndrome (AWS) and alcohol withdrawal delirium
  • abrupt withdrawal of alcohol
More risk factors

Diagnostic investigations

1st investigations to order

  • BUN and serum creatinine
  • LFTs
  • ethanol concentration
  • electrolyte panel
  • CBC
More 1st investigations to order

Investigations to consider

  • CT of head
  • chest x-ray
  • electroencephalogram (EEG)
  • blood-borne virus screen
More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

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.

  • 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
  • Patient leaflets

    Alcohol withdrawal

    More Patient leaflets
  • Calculators

    Alcohol Consumption Screening AUDIT Questionnaire

    More Calculators
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