Alcohol withdrawal resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]

Definition

Alcohol withdrawal is defined as an array of signs and symptoms that a chronic alcoholic presents with, when he abruptly ceases alcohol intake. It occurs within 6-48 hours after cessation of alcohol intake.

Diagnostic criteria

A. Sudden reduction/termination in chronic alcohol intake. B. Two (or more) of the following, developing within several hours to a few days after criterion A: 1. Autonomic hyperactivity (e.g., sweating or pulse rate > than 100/minute) 2. Hand tremors 3. Insomnia 4. Gastrointestinal upset (Nausea or vomiting) 5. Transient visual, tactile, or auditory hallucination s or illusions 6. Psychomotor agitation 7. Anxiety 8. Grand mal seizures C. The symptoms in criterion B causing clinically significant impairment of patients social, occupational or other aspects of life. D. The symptoms cannot be better explained by a general medical condition or other mental disorder.

Management

Shown below is an algorithm summarizing the approach to [[Alcohol withdrawal]].

Characterize the symptoms: Minor withdrawal symptoms: 6-12 hours ❑ Anorexia ❑ Anxiety/Palpitations ❑ Diaphoresis ❑ Gastrointestinal upset ❑ Headache ❑ Insomnia ❑ Tremulousness Alcoholic hallucinosis: 12-24 hours ❑ Visual hallucinations ❑ Auditory hallucinations ❑ Tactile hallucinations Withdrawal seizures: 24-48 hours ❑ Generalized tonic-clonic seizures Alcohol withdrawal delirium (delirium tremens): 48-72 hours ❑ Hallucinations (predominately visual) ❑ Disorientation ❑ Tachycardia ❑ Hypertension ❑ Low-grade fever ❑ Agitation ❑ Diaphoresis

References

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