Alcohol Withdrawal

Question 1

Define Alcohol Withdrawal

Answer 1

Abrupt alcohol cessation by person with alcohol dependence

Question 2

What are the risk factors for alcohol withdrawal?

Answer 2

Stop drinking abruptly

Previous alcohol withdrawal

Question 3

What are the symptoms of alcohol withdrawal?

Answer 3

Starts 4-12 hours after last drink
Tremor, restlessness
Nausea, vomiting
Headache
Delirium – insects crawling, visual, audio

Question 4

What are the signs of alcohol withdrawal?

Answer 4

Tachycardia, tachypnoea, HTN
Hyperthermia
Seizures
Delirium tremens – delusions

Question 5

What investigations would be performed for diagnosis of alcohol withdrawal? What would the findings be?

Answer 5

History: alcohol dependence (CAGE), mental status (AMTS)

Severity scores:
CIWA – 0-67
Mild <9
Moderate 9-15
Severe 15

DSM-5 Alcohol Withdrawal
PAWSS

Bloods:
U&Es – dehydration
LFTs – hepatitis
Ethanol – if high and have symptoms -> more severe withdrawal
Electrolytes – lactic acid, hypokalaemia – metabolic acidosis
FBC – rule out infection

CT head – exclude other cause
CXR – exclude other cause

Question 6

What is the management of alcohol withdrawal?

Answer 6

Benzodiazepines:
Chlordiazepoxide
Urgent – diazepam, lorazepam, phenobarbital

Supportive care:
ICU – constant monitoring
Watch for seizures
Pabrinex – nutritional supplementation

Question 7

What are the complications of alcohol withdrawal?

Answer 7

Delirium tremens

Death

Question 8

What is the prognosis of alcohol withdrawal?

Answer 8

Good if:

• monitored alcohol reduction
• slow reduction