小结
定义
病史和体格检查
关键诊断因素
- 危险因素
- 酒精依赖性
- 停止或减少酒精摄入
- 出现至少一种酒精戒断特征
- 痫样发作
- 酒精戒断性谵妄
- 激越
- 粗大震颤
- 高血压或低血压
- 发热或低体温
- 高血糖或低血糖
其他诊断因素
- 焦虑
- 恶心和呕吐
- 自主神经功能障碍
- 失眠
- 酒精渴求
- 头痛
- 厌食
- 抑郁
危险因素
- 酒精戒断综合征（AWS）和酒精戒断性谵妄史
- 酒精突然戒断
诊断性检查
首要检查
- 静脉血气
- 血糖
- 全血细胞计数
- 尿素和电解质
- 肝功能检测
- 骨骼情况
- 凝血功能检查
需考虑的检查
- 血培养
- 头颅 CT
- 胸部 X 线检查
- 心电图（ECG）
- 淀粉酶/脂肪酶
- 氨
- 腰椎穿刺：
- 脑电图（EEG）
- 血源性病毒筛查
治疗流程
疑似酒精戒断且 CIWA-Ar 得分 ≥10 或 GMAWS 得分 ≥2
疑似酒精戒断且 CIWA-Ar 得分 <10 或 GMAWS 得分 <2
撰稿人
专家顾问
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
利益声明
AA declares that he has no competing interests.
Thomas King
利益声明
TK declares that he has no competing interests.
鸣谢
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
同行评议者
Nigel Langford
Consultant Acute/General Medicine
University Hospitals of Leicester NHS Trust
Honorary Senior Lecturer
Department of Medical Education
University of Leicester
Leicester
UK
利益声明
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.
编辑
Annabel Sidwell
Section Editor, BMJ Best Practice
利益声明
AS declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
参考文献
关键文献
National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. April 2017 [internet publication].全文
Royal College of Physicians. Alcohol dependence and withdrawal in the acute hospital. June 2012 [internet publication].全文
Bråthen G, Ben-Menachem E, Brodtkorb E, et al. Chapter 29: alcohol-related seizures. In: Gilhus NE, Barnes MP, Brainin M, eds. European handbook of neurological management. 2nd ed, vol 1. Oxford, UK: Blackwell publishing; 2011:429-36.全文
Tiglao SM, Meisenheimer ES, Oh RC. Alcohol withdrawal syndrome: Outpatient management. Am Fam Physician. 2021 Sep 1;104(3):253-62. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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