Alcohol Withdrawal

Question 1

Define Alcohol Withdrawal

Answer 1

The symptoms that may occur when a person has been drinking to much alcohol on a regular basis and suddenly stops drinking

Question 2

What is the aetiology of Alcohol withdrawal?

Answer 2

• Chronic alcohol consumption supresses the activity of glutamate (an excitatory neurotransmitter), so the body compensates by increasing sensitivity to glutamate
• When alcohol consumption stops, there’s increased glutamate activity leading to excitatory symptoms

Question 3

What is the epidemiology of Alcohol Withdrawal?

Answer 3

• If untreated, 6% of alcohol-dependent patients develop clinically relevant symptoms of withdrawal
• Up to 10% will have delirium tremens

Question 4

What are the presenting symptoms/signs?

Answer 4

• History of high alcohol intake
• Mild symptoms:
  - Insomnia and fatigue
  - Mild anxiety/nervous
  - Nausea and vomiting
  - Headache
  - Sweating
  - Palpitations
  - Anorexia
  - Depression
  - Craving alcohol
• Severe symptoms:
  - Hallucinations
  - Withdrawal seizures (generalised tonic-clonic)
  - Delirium tremens

Question 5

What is Delirium Tremens?

Answer 5

• Acute confusional state often seen as withdrawal syndrome in chronic alcoholics and caused by sudden cessation of drinking alcohol.
• Can be precipitated by a head injury or acute infection causing abstinence from alcohol
• Features:
  - Anxiety
  - Tremor
  - Sweating
  - Vivid and terrifying visual and sensory hallucinations (usually animals/insects)
  - Can be FATAL

Question 6

What are the Investigations in Alcohol Withdrawal?

Answer 6

Bloods:

• U&Es: urea, Cr, metabolic acidosis
• LFTs: alcoholic hepatitis
• Toxicology screen: other drugs

CT Head (exclude other causes)

Question 7

Outline the Management of Alcohol Withdrawal

Answer 7

• Chlorodiazepoxide: reduces symptoms of alcohol withdrawal
• Barbiturates may be used if refractory to benzodiazepines
• Thiamine (Pabrinex): prevents progression to Wernicke-Korsakoff syndrome

Question 8

Identify any complications of Alcohol withdrawal

Answer 8

Patients can have seizures and die if untreated

Seizures are treated by Benzodiazepines

Question 9

Summarise the prognosis for patients with Alcohol withdrawal

Answer 9

• Delirium tremens has a mortality of 35% if untreated

- Mortality is 2% with early detection and treatment