Alcohol withdrawal

1. Alcohol withdrawal

2. Alcohol withdrawal
(NICE Pathways 2015)
• Someone who has been drinking alcohol heavily for a considerable
period of time (i.e. several days), or has been drinking heavily and
then ‘topped up’ over a period of time without respite, is in danger of
alcohol withdrawal syndrome when their blood alcohol returns to
minimum level.
• Alcohol withdrawal syndrome is a life-threatening condition.
• Immediate care is required for someone who is likely to experience
seizures or delirium tremens.
• Anyone at high or medium risk should be assessed in A&E.
• High risk individuals and those under 16 years should be
admitted to hospital.

3. Alcohol withdrawal symptoms
(Guys & St. Thomas’ NHS Foundation Trust (2012)
Symptoms and signs of alcohol withdrawal syndrome can be:
 Anxiety
 Agitation
 Irritability
 Nausea
 Vomiting
 Diarrhoea
 Convulsions
 Insomnia
Absence of any of these does not exclude withdrawal symptoms.
 Tremor of hands, tongue,
eyelids
 Hallucinations
 Sweating fever with or
without infection
 Delirium
 Tachycardia
 Hypertension

4. Alcohol withdrawal syndrome
(Guys & St. Thomas NHS Foundation Trust (2012)
• Symptoms will present within 6 – 8 hours of the last drink.
• These include epileptiform seizures within 12 to 48 hours
of alcohol cessation.
• Fits are rare beyond 48 hours following alcohol cessation.
• People with known alcohol dependency should also be
given prophylactic vitamin B supplement (Pabrinex).
Alcohol related seizures

5. • Delirium tremens (DTs) occurs in about 5% of patients undergoing
alcohol withdrawal.
• Untreated, DTs is fatal in 15-20% of patients whilst early detection
and prompt initiation of treatment usually prevents onset.
• Onset of DTs is 2-5 days (most commonly at 2-3 days) following
cessation and represents a medical emergency.
• If untreated, death may result from respiratory and cardiovascular
collapse or cardiac arrhythmias.
• Patients most at risk are those with a high fever (>104°F/39.9°C),
tachycardia, dehydration and an associated illness (e.g. pneumonia
or pancreatitis), general debility or where the diagnosis is delayed.
Delirium tremens (DTs)
Alcohol withdrawal syndrome
(Guys & St. Thomas NHS Foundation Trust (2012)

6. Delirium tremens (DTs) symptoms
• Severe tremor
• Clouding of consciousness
• Delusions
• Confusion and disorientation
• Tachycardia
• Agitation or violent behaviour
• Delirium
• Fever, with or without infection: temperature > 101°F/38.3°C
• Severe hallucinations, often evoke extreme fear (mainly visual, may
be tactile or auditory)
Alcohol withdrawal syndrome (cont.)
(Guys & St. Thomas NHS Foundation Trust (2012)

7. Immediate management of alcohol
withdrawal syndrome (NICE Pathways 2015)
• Alcohol withdrawal syndrome is commonly managed in
hospital through a reducing dose of benzodiazepines
(diazepam or chlordiazepoxide). Clormethiazole may be
prescribed for admitted inpatients.
• Delirium tremens should be treated firstly with a quick-acting
benzodiazepine (lorazepam) and psychotic symptoms should
be managed with haloperidol or olanzapine.
• Symptoms should be observed and recorded to determine the
effectiveness of the treatment.

8. References
• Guys and St Thomas NHS Foundation Trust (2012) Clinical Guideline. DTC
Reference 10052a. Available at: http://www.guysandstthomas.nhs.uk/resources/our-
services/acute-medicine-gi-surgery/elderly-care/alcohol-withdrawal-syndrome.pdf
• NICE Pathways (2015) Acute alcohol withdrawal. Accessed 28.7.15. Available at:
http://pathways.nice.org.uk/pathways/alcohol-use-disorders/acute-alcohol-withdrawal