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Alcohol withdrawal management

Alcohol withdrawal syndrome

The alcohol withdrawal syndrome is a set of clinical features that can occur when a person reduces or abruptly stops alcohol consumption after long periods of use.

Prolonged and excessive use of alcohol leads to tolerance and physical dependence. Withdrawal does not occur in non-dependent people.

The withdrawal syndrome is a hyper-excitable response of the central nervous system (CNS) due to lack of the sedative effect of alcohol after long term exposure to high levels of alcohol.

Symptoms of withdrawal usually appear six to 24 hours after the patient’s last drink and include:

  • tremor
  • sweats
  • nausea and/or vomiting, poor appetite, diarrhoea
  • headache
  • anxiety/restlessness.

Other signs of withdrawal syndrome include:

  • elevated heart rate and blood pressure
  • seizures (occur in approximately 15% of cases, typically one to three days after the patient’s last drink)
  • development of confusion or delirium.

Worsening withdrawal at three to 10 days after the person’s last drink may indicate onset of delirium tremens (a medical emergency). Urgent transfer to hospital is recommended – carers should be urged to call an ambulance on 000.

Predictors of alcohol withdrawal

Significant withdrawal is unlikely in people aged less than 30 years or remains asymptomatic >72 hours after BAC 0.00 (and has not received other CNS depressants).

Significant withdrawal is likely:

  • in men who have more than eight standard drinks a day and women that have more than six standard drinks a day
  • if the person has been drinking daily, at this level, for at least two weeks (withdrawal is unlikely with shorter periods of use or intermittent/binge pattern of use)
  • if the person’s last drink was in the past six to 24 hours
  • if the person has previously experienced a withdrawal syndrome
  • if the person has their first drink early in the morning.

Alcohol withdrawal management

Withdrawal management focuses on:

  • prevention of severe withdrawal
  • reducing the risk of injury (self/others) due to altered mental state
  • reducing the risk of dehydration, electrolyte and nutritional imbalance
  • preventing seizures
  • identification and treatment of concurrent medical conditions that can mask or mimic withdrawal or complicate the withdrawal process.

Monitoring

A validated instrument such as the CIWA-Ar (PDF 45KB) should be used to assess withdrawal severity and track changes in withdrawal over time.

  • had a previous severe withdrawal
  • had previous seizures as a result of withdrawal
  • had previous delirium as a result of withdrawal
  • other physical health problems such as heart disease or severe liver disease
  • had several attempts at withdrawing at home unsuccessfully.
  • dependence on several substances been unable to secure stable residential accommodation where an appropriate support person can monitor them and assist with medication administration.

Inpatient withdrawal management

Withdrawal management in an ambulatory/home setting.

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