Alcohol withdrawal is the experience that individuals have when they decide to stop taking alcohol or take low amounts after they have been dependent on it for a long. It is a clinical state with autonomic dysfunction that presents with restlessness and nervousness, increased activity, anxiety, muscle cramps, overactivity of tendon reflexes, raised blood pressure, profuse sweating, increased pulse rate, and fever. That is why it develops within 6 to 24 hours after cessation or significantly reduced use of the substance.
Epidemiology
The incidence of alcohol withdrawal is 50 percent among all the people who abuse alcohol. It is unfortunate to find that about 40 percent of the patients with alcohol abuse end up in emergency care and 82 to 87% of the patients admitted to emergency care with traumatology were male, and 43 percent of them were above 55 years.
Anatomy
Pathophysiology
Ethanol also has specific receptors on GABA; however, the overall effect enhances CNS inhibition when present. Alcohol, with time, causes the brain to be constantly depressed through consistent sensitization of GABA receptors.
Ethanol also could interact with another receptor, glutamate which is an excitatory amino acid in CNS. With the interaction with the glutamate, it increases the low level of CNS activity thus increasing depression.
Etiology
The consistent use of alcohol drinkers opt for ethanol, which is a CNS depressant. With longer time use of ethanol, their body becomes dependent on it. This is possible through inhibition of CNS glutamate receptors and at the same time increasing the GABA receptors. Depressants are a type of medication that decreases reliability in the central nervous system; if depressants are made, the CNS is overactive as competence diminishes when depressants stop. Thus, the body receives an excitatory message and withdrawals symptoms are present.
Genetics
Prognostic Factors
The prognosis of the condition depends on the level of the disorder. Worsening of the outcomes can be evidenced in the case of the patients who need longer stays in and out of the intensive care unit.
The patients who go to delirium tremens tend to be associated with higher mortality rates.
Clinical History
Onset: The symptoms normally arise within several hours to a few days upon the last time the alcohol was taken.
Symptoms: The symptoms that are expressed have higher prevalence include tremor, sweating, nausea or vomiting, insomnia or hypersomnia, headache, palpitation. Mild symptoms include hallucinations while severe ones comprise of seizure that is known as alcohol withdrawal seizures and delirium tremens that is lethal.
Age group: The condition is most noted among those who consume alcohol on a regular basis over quite some time, preferably those who are above 18 years of age.
Physical Examination
Vital Signs
Neurological Examination
Gastrointestinal Symptoms
Autonomic Symptoms
Skin Examination
Age group
Associated comorbidity
Coexisting Medical Conditions
Age and General Health
Amount and Duration of Alcohol Use
Polydrug Use
Psychiatric Comorbidities
Nutritional Status
Associated activity
Acuity of presentation
The nature of presentation of alcohol withdrawal syndrome may not always be characteristic in any given case since other factors do pose an influence on the presentation; these are characteristics like duration and intensity of alcohol use before withdrawal, the general state of heath of the person, or context in which the withdrawal syndrome is being handled.
Differential Diagnoses
Delirium Tremens (DTs)
Seizure Disorders
Metabolic Disturbances
Psychiatric Disorders
Neurological Disorders
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Assessment: Determine the severity of withdrawal signs, symptoms, presence, and severity of other medical and psychiatric comorbid conditions.
Medical Management:
Benzodiazepines: These are used to deal with withdrawal effects, or to prevent one from having a seizure. Lorazepam, diazepam, and chlordiazepoxide are some of the popular BZDs employed in clinical settings.
Anticonvulsants: In case benzodiazepines are not available or should not be administered carbamazepine or valproate anticonvulsive agents can be used.
Supportive Care:
Fluid and Electrolyte Management: Most of the patients with the alcohol use disorder are always in a position that some of the important minerals are lacking in their body system.
Nutritional Support: For malnutrition that is common with chronic alcoholics, it offers supplementation of vitamins and other minerals.
Psychosocial Support:
Counseling and Therapy: It is imperative that the causes for the development of alcohol use disorder be remedied to ensure that people will not be drawn towards the substance.
Support Groups: At the end of the treatment, the patient should be encouraged to attend support group such as Alcoholics Anonymous (AA).
Monitoring: Some of the patients present symptoms requiring medical intervention; these are the DTs, seizure, and other medical conditions in the period of acute withdrawal.
Long-Term Management: The need for rehabilitation does not only concern the improvement of the patient’s condition and their need to prevent relapse and maintain abstinence, but a systematic approach to the creation of psychological and medical programs and behavioral therapies.
Assessment: Determine the severity of withdrawal signs, symptoms, presence, and severity of other medical and psychiatric comorbid conditions.
Medical Management: Benzodiazepines: These are used to deal with withdrawal effects, or to prevent one from having a seizure. Lorazepam, diazepam, and chlordiazepoxide are some of the popular BZDs employed in clinical settings.
Anticonvulsants: In case benzodiazepines are not available or should not be administered carbamazepine or valproate anticonvulsive agents can be used.
Supportive Care:
Fluid and Electrolyte Management: Most of the patients with the alcohol use disorder are always in a position that some of the important minerals are lacking in their body system.
Nutritional Support: For malnutrition that is common with chronic alcoholics, it offers supplementation of vitamins and other minerals.
Psychosocial Support:
Counseling and Therapy: It is imperative that the causes for the development of alcohol use disorder be remedied to ensure that people will not be drawn towards the substance.
Support Groups: At the end of the treatment, the patient should be encouraged to attend support group such as Alcoholics Anonymous (AA).
Monitoring: Some of the patients present symptoms requiring medical intervention; these are the DTs, seizure, and other medical conditions in the period of acute withdrawal.
Long-Term Management: The need for rehabilitation does not only concern the improvement of the patient’s condition and their need to prevent relapse and maintain abstinence, but a systematic approach to the creation of psychological and medical programs and behavioral therapies.
Role of Benzodiazepines in treating Alcohol withdrawal syndrome
Diazepam and lorazepam: These are the drugs used in treatment of alcohol withdrawal in patients. They help in lessening of withdrawal symptoms and preventing of seizures.
Effectiveness of Beta-blockers in treating Alcohol withdrawal syndrome
Propranolol: Propranolol indications include hypertension and tachycardia, which are the symptoms of cardiovascular system.
Assessment and Diagnosis: It is necessary to determine the severity of withdrawal symptoms that are shown and the presence of any other health disorders.
Initial Stabilization: Interventions like providing drinks and meals and assessing patients physiological indicators.
Pharmacological Management: Administer drugs such as benzodiazepines, including diazepam and lorazepam, for treating withdrawal symptoms and some serious consequences, such as seizures.
Long-term Treatment and Support: For subsequent care which may require the patient to attend counseling and group therapy sessions.
Each capsule of clomethiazole contains base 192 mg: Administer 9 to 12 capsules in a day in divided doses on 1st day.
May reduce the dose gradually for the next five days.
Do not use it for more than 9 days.
»
Home » CAD » Alcohol withdrawal syndrome (AWS)
Alcohol withdrawal syndrome (AWS)
Updated :
July 10, 2024
Alcohol withdrawal is the experience that individuals have when they decide to stop taking alcohol or take low amounts after they have been dependent on it for a long. It is a clinical state with autonomic dysfunction that presents with restlessness and nervousness, increased activity, anxiety, muscle cramps, overactivity of tendon reflexes, raised blood pressure, profuse sweating, increased pulse rate, and fever. That is why it develops within 6 to 24 hours after cessation or significantly reduced use of the substance.
The incidence of alcohol withdrawal is 50 percent among all the people who abuse alcohol. It is unfortunate to find that about 40 percent of the patients with alcohol abuse end up in emergency care and 82 to 87% of the patients admitted to emergency care with traumatology were male, and 43 percent of them were above 55 years.
Ethanol also has specific receptors on GABA; however, the overall effect enhances CNS inhibition when present. Alcohol, with time, causes the brain to be constantly depressed through consistent sensitization of GABA receptors.
Ethanol also could interact with another receptor, glutamate which is an excitatory amino acid in CNS. With the interaction with the glutamate, it increases the low level of CNS activity thus increasing depression.
The consistent use of alcohol drinkers opt for ethanol, which is a CNS depressant. With longer time use of ethanol, their body becomes dependent on it. This is possible through inhibition of CNS glutamate receptors and at the same time increasing the GABA receptors. Depressants are a type of medication that decreases reliability in the central nervous system; if depressants are made, the CNS is overactive as competence diminishes when depressants stop. Thus, the body receives an excitatory message and withdrawals symptoms are present.
The prognosis of the condition depends on the level of the disorder. Worsening of the outcomes can be evidenced in the case of the patients who need longer stays in and out of the intensive care unit.
The patients who go to delirium tremens tend to be associated with higher mortality rates.
Onset: The symptoms normally arise within several hours to a few days upon the last time the alcohol was taken.
Symptoms: The symptoms that are expressed have higher prevalence include tremor, sweating, nausea or vomiting, insomnia or hypersomnia, headache, palpitation. Mild symptoms include hallucinations while severe ones comprise of seizure that is known as alcohol withdrawal seizures and delirium tremens that is lethal.
Age group: The condition is most noted among those who consume alcohol on a regular basis over quite some time, preferably those who are above 18 years of age.
Vital Signs
Neurological Examination
Gastrointestinal Symptoms
Autonomic Symptoms
Skin Examination
Coexisting Medical Conditions
Age and General Health
Amount and Duration of Alcohol Use
Polydrug Use
Psychiatric Comorbidities
Nutritional Status
The nature of presentation of alcohol withdrawal syndrome may not always be characteristic in any given case since other factors do pose an influence on the presentation; these are characteristics like duration and intensity of alcohol use before withdrawal, the general state of heath of the person, or context in which the withdrawal syndrome is being handled.
Delirium Tremens (DTs)
Seizure Disorders
Metabolic Disturbances
Psychiatric Disorders
Neurological Disorders
Assessment: Determine the severity of withdrawal signs, symptoms, presence, and severity of other medical and psychiatric comorbid conditions.
Medical Management:
Benzodiazepines: These are used to deal with withdrawal effects, or to prevent one from having a seizure. Lorazepam, diazepam, and chlordiazepoxide are some of the popular BZDs employed in clinical settings.
Anticonvulsants: In case benzodiazepines are not available or should not be administered carbamazepine or valproate anticonvulsive agents can be used.
Supportive Care:
Fluid and Electrolyte Management: Most of the patients with the alcohol use disorder are always in a position that some of the important minerals are lacking in their body system.
Nutritional Support: For malnutrition that is common with chronic alcoholics, it offers supplementation of vitamins and other minerals.
Psychosocial Support:
Counseling and Therapy: It is imperative that the causes for the development of alcohol use disorder be remedied to ensure that people will not be drawn towards the substance.
Support Groups: At the end of the treatment, the patient should be encouraged to attend support group such as Alcoholics Anonymous (AA).
Monitoring: Some of the patients present symptoms requiring medical intervention; these are the DTs, seizure, and other medical conditions in the period of acute withdrawal.
Long-Term Management: The need for rehabilitation does not only concern the improvement of the patient’s condition and their need to prevent relapse and maintain abstinence, but a systematic approach to the creation of psychological and medical programs and behavioral therapies.
Emergency Medicine
Treatment paradigm
Assessment: Determine the severity of withdrawal signs, symptoms, presence, and severity of other medical and psychiatric comorbid conditions.
Medical Management: Benzodiazepines: These are used to deal with withdrawal effects, or to prevent one from having a seizure. Lorazepam, diazepam, and chlordiazepoxide are some of the popular BZDs employed in clinical settings.
Anticonvulsants: In case benzodiazepines are not available or should not be administered carbamazepine or valproate anticonvulsive agents can be used.
Supportive Care:
Fluid and Electrolyte Management: Most of the patients with the alcohol use disorder are always in a position that some of the important minerals are lacking in their body system.
Nutritional Support: For malnutrition that is common with chronic alcoholics, it offers supplementation of vitamins and other minerals.
Psychosocial Support:
Counseling and Therapy: It is imperative that the causes for the development of alcohol use disorder be remedied to ensure that people will not be drawn towards the substance.
Support Groups: At the end of the treatment, the patient should be encouraged to attend support group such as Alcoholics Anonymous (AA).
Monitoring: Some of the patients present symptoms requiring medical intervention; these are the DTs, seizure, and other medical conditions in the period of acute withdrawal.
Long-Term Management: The need for rehabilitation does not only concern the improvement of the patient’s condition and their need to prevent relapse and maintain abstinence, but a systematic approach to the creation of psychological and medical programs and behavioral therapies.
Emergency Medicine
Diazepam and lorazepam: These are the drugs used in treatment of alcohol withdrawal in patients. They help in lessening of withdrawal symptoms and preventing of seizures.
Emergency Medicine
Propranolol: Propranolol indications include hypertension and tachycardia, which are the symptoms of cardiovascular system.
Emergency Medicine
Assessment and Diagnosis: It is necessary to determine the severity of withdrawal symptoms that are shown and the presence of any other health disorders.
Initial Stabilization: Interventions like providing drinks and meals and assessing patients physiological indicators.
Pharmacological Management: Administer drugs such as benzodiazepines, including diazepam and lorazepam, for treating withdrawal symptoms and some serious consequences, such as seizures.
Long-term Treatment and Support: For subsequent care which may require the patient to attend counseling and group therapy sessions.
Alcohol withdrawal is the experience that individuals have when they decide to stop taking alcohol or take low amounts after they have been dependent on it for a long. It is a clinical state with autonomic dysfunction that presents with restlessness and nervousness, increased activity, anxiety, muscle cramps, overactivity of tendon reflexes, raised blood pressure, profuse sweating, increased pulse rate, and fever. That is why it develops within 6 to 24 hours after cessation or significantly reduced use of the substance.
The incidence of alcohol withdrawal is 50 percent among all the people who abuse alcohol. It is unfortunate to find that about 40 percent of the patients with alcohol abuse end up in emergency care and 82 to 87% of the patients admitted to emergency care with traumatology were male, and 43 percent of them were above 55 years.
Ethanol also has specific receptors on GABA; however, the overall effect enhances CNS inhibition when present. Alcohol, with time, causes the brain to be constantly depressed through consistent sensitization of GABA receptors.
Ethanol also could interact with another receptor, glutamate which is an excitatory amino acid in CNS. With the interaction with the glutamate, it increases the low level of CNS activity thus increasing depression.
The consistent use of alcohol drinkers opt for ethanol, which is a CNS depressant. With longer time use of ethanol, their body becomes dependent on it. This is possible through inhibition of CNS glutamate receptors and at the same time increasing the GABA receptors. Depressants are a type of medication that decreases reliability in the central nervous system; if depressants are made, the CNS is overactive as competence diminishes when depressants stop. Thus, the body receives an excitatory message and withdrawals symptoms are present.
The prognosis of the condition depends on the level of the disorder. Worsening of the outcomes can be evidenced in the case of the patients who need longer stays in and out of the intensive care unit.
The patients who go to delirium tremens tend to be associated with higher mortality rates.
Onset: The symptoms normally arise within several hours to a few days upon the last time the alcohol was taken.
Symptoms: The symptoms that are expressed have higher prevalence include tremor, sweating, nausea or vomiting, insomnia or hypersomnia, headache, palpitation. Mild symptoms include hallucinations while severe ones comprise of seizure that is known as alcohol withdrawal seizures and delirium tremens that is lethal.
Age group: The condition is most noted among those who consume alcohol on a regular basis over quite some time, preferably those who are above 18 years of age.
Vital Signs
Neurological Examination
Gastrointestinal Symptoms
Autonomic Symptoms
Skin Examination
Coexisting Medical Conditions
Age and General Health
Amount and Duration of Alcohol Use
Polydrug Use
Psychiatric Comorbidities
Nutritional Status
The nature of presentation of alcohol withdrawal syndrome may not always be characteristic in any given case since other factors do pose an influence on the presentation; these are characteristics like duration and intensity of alcohol use before withdrawal, the general state of heath of the person, or context in which the withdrawal syndrome is being handled.
Delirium Tremens (DTs)
Seizure Disorders
Metabolic Disturbances
Psychiatric Disorders
Neurological Disorders
Assessment: Determine the severity of withdrawal signs, symptoms, presence, and severity of other medical and psychiatric comorbid conditions.
Medical Management:
Benzodiazepines: These are used to deal with withdrawal effects, or to prevent one from having a seizure. Lorazepam, diazepam, and chlordiazepoxide are some of the popular BZDs employed in clinical settings.
Anticonvulsants: In case benzodiazepines are not available or should not be administered carbamazepine or valproate anticonvulsive agents can be used.
Supportive Care:
Fluid and Electrolyte Management: Most of the patients with the alcohol use disorder are always in a position that some of the important minerals are lacking in their body system.
Nutritional Support: For malnutrition that is common with chronic alcoholics, it offers supplementation of vitamins and other minerals.
Psychosocial Support:
Counseling and Therapy: It is imperative that the causes for the development of alcohol use disorder be remedied to ensure that people will not be drawn towards the substance.
Support Groups: At the end of the treatment, the patient should be encouraged to attend support group such as Alcoholics Anonymous (AA).
Monitoring: Some of the patients present symptoms requiring medical intervention; these are the DTs, seizure, and other medical conditions in the period of acute withdrawal.
Long-Term Management: The need for rehabilitation does not only concern the improvement of the patient’s condition and their need to prevent relapse and maintain abstinence, but a systematic approach to the creation of psychological and medical programs and behavioral therapies.
Emergency Medicine
Treatment paradigm
Assessment: Determine the severity of withdrawal signs, symptoms, presence, and severity of other medical and psychiatric comorbid conditions.
Medical Management: Benzodiazepines: These are used to deal with withdrawal effects, or to prevent one from having a seizure. Lorazepam, diazepam, and chlordiazepoxide are some of the popular BZDs employed in clinical settings.
Anticonvulsants: In case benzodiazepines are not available or should not be administered carbamazepine or valproate anticonvulsive agents can be used.
Supportive Care:
Fluid and Electrolyte Management: Most of the patients with the alcohol use disorder are always in a position that some of the important minerals are lacking in their body system.
Nutritional Support: For malnutrition that is common with chronic alcoholics, it offers supplementation of vitamins and other minerals.
Psychosocial Support:
Counseling and Therapy: It is imperative that the causes for the development of alcohol use disorder be remedied to ensure that people will not be drawn towards the substance.
Support Groups: At the end of the treatment, the patient should be encouraged to attend support group such as Alcoholics Anonymous (AA).
Monitoring: Some of the patients present symptoms requiring medical intervention; these are the DTs, seizure, and other medical conditions in the period of acute withdrawal.
Long-Term Management: The need for rehabilitation does not only concern the improvement of the patient’s condition and their need to prevent relapse and maintain abstinence, but a systematic approach to the creation of psychological and medical programs and behavioral therapies.
Emergency Medicine
Diazepam and lorazepam: These are the drugs used in treatment of alcohol withdrawal in patients. They help in lessening of withdrawal symptoms and preventing of seizures.
Emergency Medicine
Propranolol: Propranolol indications include hypertension and tachycardia, which are the symptoms of cardiovascular system.
Emergency Medicine
Assessment and Diagnosis: It is necessary to determine the severity of withdrawal symptoms that are shown and the presence of any other health disorders.
Initial Stabilization: Interventions like providing drinks and meals and assessing patients physiological indicators.
Pharmacological Management: Administer drugs such as benzodiazepines, including diazepam and lorazepam, for treating withdrawal symptoms and some serious consequences, such as seizures.
Long-term Treatment and Support: For subsequent care which may require the patient to attend counseling and group therapy sessions.
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