Alcohol Withdrawal

Synonyms and related conditions:

Alcohol withdrawal seizures & delirium tremens DT

Diagnosis:

This is a clinical diagnosis

Clinical features

Within 6-36 hours of cessation of/decrease in alcohol consumption,
Autonomic symptoms: diaphoresis, tachycardia, and hypertension
Neurological symptoms: tremor, anxiety, hallucinations (tactile, visual or auditory), agitation, seizures, headache, insomnia.
Delirium tremens DTs:

  • Alcohol withdrawal
  • +disorientation, confusion, agitation or hallucination

Alcohol hallucinosis:

  • Alcohol withdrawal
  • +Auditory hallucinations, without consciousness disturbance,

Scales & questionnaires:

CAGE questionnaire
Clinical Institute Withdrawal Assessment for Alcohol-Revised CIWA-Ar score:

  • Mild <10
  • Moderate 10-20
  • Severe >20

Investigations to consider:

FBC (megalobastic anemia),
U&E, Mg++: hypokalemia, hypomagnesemia,
Liver enzymes:

  • In hepatitis: AST:ALT ratio > 2:1, AST rarely >300 U/L

B1 Thiamine: by functional transketolase assay, thiamine chromatography or urinary thiamine
Glucose: hypoglycemia

Monitor:

  • Vitals in acute setting
  • Signs of withdrawal

Treatment:

Symptom triggered dosing of Benzodiazepines: diazepam P.O. or chlorediazepoxide P.O., or lorazepam I.V.
Consider Carbamazepine CBZ P.O. if recurrent.
Thiamine repletion, Adequate nutrition & correct electrolyte abnormalities:

  • If liver disease: High calorie & High protein
  • Multivitamin, thiamine B, folate,
  • Correct electrolyte abnormalities & hypoglycemia: routine magnesium sulfate is not indicated.
  • NB. Never give dextrose or glucose before correcting thiamine deficiency in these patients.

Addiction/depedence counselling

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