Alcohol Withdrawal

Question 1

Define Alcohol withdrawal

Answer 1

Alcohol withdrawal syndrome occurs when an alcohol dependent person decreases or stops their intake. It normally begins 4-12 hours after the patients last drink.

Question 2

What is the aetiology of alcohol withdrawal?

Answer 2

Blood alcohol level drops below what the patient normally has causing withdrawal symptoms
Common where there is a family history or abrupt withdrawal

Question 3

Who and where is alcohol withdrawal prevalent?

Answer 3

Over 15’s (more in 18-25 than over 26)

Binge drinkers>excessive drinkers

Question 4

What are the symptoms of alcohol withdrawal?

Answer 4

Alcohol use
Change in mental status
Hallucinations
Delusions

Question 5

What are the signs of alcohol withdrawal?

Answer 5

Tremor
Hypertension
Nause/ vomiting

Question 6

What are the investigations of alcohol withdrawal and how would you interpret them?

Answer 6

Bloods
> U&E- lactic acidosis, dehydration (low U), hypokalaemia
> Cr- elevated
> Ethanol- positive
> FBC- infection risk
CT head (normal, rules out differentials)
CXR (normal, rules out differentials)

Question 7

What is the management of alcohol withdrawal?

Answer 7

Benzodiazepine/ clomethiazone
Supportive care
ADJUNCTS: Phenobarbital/ Vitamin supplements/ propofol/ dexmedetomidine

Question 8

What are the complications of alcohol withdrawal?

Answer 8

Delirium tremens
Over sedation
Seizures
Status epilepticus
Death

Question 9

What is the prognosis of alcohol withdrawal?

Answer 9

Relapse may occur

Generally not deadly if well controlled