Acute Alcohol Withdrawal

Question 1

What are the risk factors for serious acute alcohol withdrawal?

Answer 1

Abrupt cessation of alcohol

Previous history of severe withdrawal

Question 2

What are the potential symptoms / signs of acute alcohol withdrawal?

Answer 2

Nausea and vomiting
Anxiety
Insomnia 
Sweating
Tachycardia
Confusion / delirium
Tremors
Seizures - generalised tonic clonic
Transient hallucinations

Question 3

What are the signs / symptoms of wernicke’s encephalopathy?

Answer 3

Severe, permanent anterograde amnesia
Confabulation
Opthalmoplegia
Ataxia
Apathy
Altered mental status

Question 4

What investigations should be conducted in suspected acute alcohol withdrawal?

Answer 4

FBC
LFTs
U+Es
CRP
Coagulation 
Bone profile
VBG
Glucose
CT head

Question 5

Describe the management of acute alcohol withdrawal?

Answer 5

Pharmacological - benzodiazepines (usually oral lorazepam, though not always required), add antipsychotic if needed
Nutritional support - Pabrinex
Supportive care - IV fluids, correction of electrolyte/glucose abnormalities, ongoing monitoring
Manage in a calm and quiet environment

Question 6

What are the potential complications of acute alcohol withdrawal?

Answer 6

Seizures
Status epilepticus
Permanent brain damage
Wernicke's encephalopathy / Korsakoff's 
Death