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Alcohol withdrawal syndrome (AWS)

Updated : September 17, 2022





Background

When individuals quit drinking or dramatically reduce their alcohol consumption after a long period of dependence, they experience alcohol withdrawal symptoms.

It characterizes as a clinical condition represented by symptoms of autonomic hyperactivity, such as irritability, agitation, anxiety, tremors, confusion, hyperreflexia, hypertension, diaphoresis, tachycardia, and fever.

It develops within 6 to 24 hours after discontinuation or low consumption.

Epidemiology

About 50% of the individuals who abuse alcohol develop withdrawal symptoms. Approximately 40% of the patients with alcohol abuse end up in emergency care.

Nearly 83% of patients presenting to emergency care with trauma were male, and 43% of them were above 55 years. Symptoms of AWS were seen in about 52% of the inpatients.

Delirium tremens is life-threatening in almost 15% of cases without intervention and 1% of the treated cases.

Anatomy

Pathophysiology

GABA (gamma-aminobutyric acid) is the most important inhibitory neurotransmitter in the central nervous system. GABA has specific binding sites for ethanol, which increases CNS inhibition.

Chronic exposure of ethanol to GABA causes the brain to be constantly inhibited or depressed. Ethanol similarly binds with glutamate, an excitatory amino acid in the central nervous system.

When it interacts with glutamate, it decreases central nervous system excitement, exacerbating depression.

Etiology

Chronic alcohol users primarily consume ethanol, a central nervous system depressant. With prolonged exposure to ethanol, the body becomes dependent. It attains this by suppressing CNS glutamate receptors and increasing GABA receptors.

When a depressant is discontinued, the CNS becomes overexcited since the inhibition is removed. As a result, the body experiences an excitatory surge, resulting in withdrawal symptoms.

Genetics

Prognostic Factors

The prognosis depends on the severity of the condition. Worse outcomes can occur in patients requiring prolonged intensive care admission and hospital stay. The patients who progress to delirium tremens often have higher mortality rates.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

diazepam

10

mg

Tablet

Orally 

every 8 hrs



diazepam 

Orally 

every 8 hrs



chlormethiazole 

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.



tofisopam 

50-100 mg orally, once to thrice daily



clonidine 

(Off-Label)
In alcohol-addicted patients, when admitted, the starting dose to manage withdrawal is 0.3 to 0.6 mg of oral administration in 6 hours:



Dose Adjustments

Not Available

 
 

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References

https://www.ncbi.nlm.nih.gov/books/NBK441882/

Alcohol withdrawal syndrome (AWS)

Updated : September 17, 2022




When individuals quit drinking or dramatically reduce their alcohol consumption after a long period of dependence, they experience alcohol withdrawal symptoms.

It characterizes as a clinical condition represented by symptoms of autonomic hyperactivity, such as irritability, agitation, anxiety, tremors, confusion, hyperreflexia, hypertension, diaphoresis, tachycardia, and fever.

It develops within 6 to 24 hours after discontinuation or low consumption.

About 50% of the individuals who abuse alcohol develop withdrawal symptoms. Approximately 40% of the patients with alcohol abuse end up in emergency care.

Nearly 83% of patients presenting to emergency care with trauma were male, and 43% of them were above 55 years. Symptoms of AWS were seen in about 52% of the inpatients.

Delirium tremens is life-threatening in almost 15% of cases without intervention and 1% of the treated cases.

GABA (gamma-aminobutyric acid) is the most important inhibitory neurotransmitter in the central nervous system. GABA has specific binding sites for ethanol, which increases CNS inhibition.

Chronic exposure of ethanol to GABA causes the brain to be constantly inhibited or depressed. Ethanol similarly binds with glutamate, an excitatory amino acid in the central nervous system.

When it interacts with glutamate, it decreases central nervous system excitement, exacerbating depression.

Chronic alcohol users primarily consume ethanol, a central nervous system depressant. With prolonged exposure to ethanol, the body becomes dependent. It attains this by suppressing CNS glutamate receptors and increasing GABA receptors.

When a depressant is discontinued, the CNS becomes overexcited since the inhibition is removed. As a result, the body experiences an excitatory surge, resulting in withdrawal symptoms.

The prognosis depends on the severity of the condition. Worse outcomes can occur in patients requiring prolonged intensive care admission and hospital stay. The patients who progress to delirium tremens often have higher mortality rates.

diazepam

10

mg

Tablet

Orally 

every 8 hrs



diazepam 

Orally 

every 8 hrs



chlormethiazole 

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.



tofisopam 

50-100 mg orally, once to thrice daily



clonidine 

(Off-Label)
In alcohol-addicted patients, when admitted, the starting dose to manage withdrawal is 0.3 to 0.6 mg of oral administration in 6 hours:



Dose Adjustments

Not Available

https://www.ncbi.nlm.nih.gov/books/NBK441882/