Management of problematic alcohol use (including alcohol withdrawal)
PDF 63 KB
A flow chart to determine what steps to take in the management of a patient with problematic alcohol use.
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:
Other signs of withdrawal syndrome include:
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.
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:
Withdrawal management focuses on:
A validated instrument such as the Alcohol Withdrawal Assessment CIWA-Ar (PDF 45KB) should be used to assess withdrawal severity and track changes in withdrawal over time.
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This service does not provide proxy medical cover and cannot assume responsibility for direct patient care.