Alcohol withdrawal
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alcohol withdrawal syndrome treatment guideline benzodiazepines thiamine ASAM
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https://www.ncbi.nlm.nih.gov/books/NBK604324
Alcohol withdrawal can be life-threatening, especially after heavy or regular drinking followed by suddenly stopping or sharply reducing alcohol.
Symptoms and usual timing
Symptoms may begin within hours of the last drink and can occur up to 4-5 days later:
- Tremor, sweating, anxiety, nausea/vomiting
- Fast pulse, high blood pressure, poor sleep
- Hallucinations, often with preserved awareness early on
- Seizures, which can occur even without other prominent symptoms
- Delirium tremens (DTs): confusion, severe agitation, fever, hallucinations, seizures, and marked autonomic instability. This is an emergency. The Washington Manual of Medical Therapeutics, p. 1098.
Get emergency help now if there is
- A seizure
- Confusion, disorientation, severe agitation, or hallucinations
- Fever, chest pain, fainting, severe vomiting, trouble breathing, or inability to keep fluids down
- A history of withdrawal seizures or DTs
- Pregnancy, serious liver/heart disease, or concurrent sedative/opioid use
Call your local emergency number or go to an emergency department. Do not drive yourself.
Treatment
Clinicians assess severity and monitor vital signs, hydration, electrolytes, and complications. Benzodiazepines are first-line treatment and reduce withdrawal symptoms, seizures, DTs, and death. Thiamine is commonly provided to prevent Wernicke encephalopathy, particularly when nutrition has been poor. Moderate-severe withdrawal, past seizures/DTs, medical or psychiatric illness, or lack of reliable supervision generally require inpatient treatment. Symptom to Diagnosis: An Evidence-Based Guide, Treatment section.
Do not try to self-treat severe withdrawal with alcohol, sedatives, or someone else’s medication. Detoxification is only the first step: continuing treatment for alcohol use disorder helps prevent relapse, as emphasized in the ASAM withdrawal-management guideline.
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