Alcohol Withdrawal

Clinical manifestations

  • Minor withdrawal sx (6–48 h after last drink): mild anxiety, tremulousness, HA
  • Withdrawal seizures: typically w/in 48 h after last drink; if unRx’d, 1/3 → delirium tremens
  • Alcoholic hallucinosis: isolated hallucinations (typically visual) 12–48 h after last drink
  • Delirium tremens (DT): disorientation, agitation, hallucinations, ↑ HR & BP, fever, diaphoresis; begins 48–96 h after last drink, lasts 5–7 d
  • Consider other dx: CNS infxn or bleed, sz, drug O/D, coingestions, acute liver failure, GIB
  • Ten-item scale (CIWA-Ar) used to assess and manage alcohol withdrawal (see Appendix)

Treatment (