Alcohol Withdrawal

Question 1

What are some of the early symptoms of alcohol withdrawal and when do they start?

Answer 1

Typically appear within 6-8 hours and include:
Anxiety
Restlessness
Tremor 
Sweating 
Nausea and vomiting 

These symptoms will peak after 10-30 hours and then will start to subside

SEIZURES can occur within the first 24-48 hours especially in people with co-morbid epilepsy

Question 2

Which symptoms of alcohol withdrawal are due to autonomic hyper-activity?

Answer 2

Tachycardia 
Hyper-relfexia 
Hypertension
Fever 
Visual or tactile hallucinations 
Delusions
Disorientation

Question 3

What serious syndrome can occur after alcohol withdrawal in chronic alcohol users and when does it occur?
How long does it last for?

Answer 3

DELIRIUM TREMENS (usually starts 2-3 days after stopping alcohol)

Will last for a further 2-3 days

Question 4

How does DT present?

Answer 4

ACUTE CONFUSIONAL STATE 
Shaking
Sweating
Increased heart rate 
Seizures 
Pseudohallucinations

Question 5

What neurological syndrome can occur in alcohol withdrawal? Why does it occur and how does it present?

Answer 5

WERNICKE-KORSAKOFF SYNDROME
Complication of acute thiamine deficiency
Acute confusion, ataxia, nystagmus, ophthalmoplegia

Can develop long-term memory problems

Question 6

How do we treat alcohol withdrawal?

Answer 6

CHLORDIAZEPOXIDE (lorazepam also useful in DT)
B-complex vitamins to prevent wernicke-korsakoff - PABRINEX together with oral thiamine

Atenolol or propanol for hypertension
Carbamazepine for seizures
Haloperidol for hallucinations