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:
nausea and/or vomiting, poor appetite, diarrhoea
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
identification and treatment of concurrent medical conditions that can mask or mimic withdrawal or complicate the withdrawal process.
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.
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.
DACAS provides a telephone and email service for South Australian health professionals seeking clinical information and clarification around clinical procedures, guidelines and evidence-based practice.
Telephone: (08) 7087 1742 from 8:30am — 10pm 7 days/week including public holidays or e-mail your enquiry to: HealthDACASEnquiries@sa.gov.au. Out of
these hours, medically urgent calls from a hospital based Medical
Consultant or country hospital medical officer/GP will always receive a response.
This service does not provide proxy medical cover and cannot
assume responsibility for direct patient care.
You can search through to find related information.
Management of problematic alcohol use (including alcohol withdrawal)
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Pharmacotherapies indicated for alcohol dependence
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DASSA Monograph No 26 - 2011
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Treatment options for alcohol or other drug problems
Information about the various treatments options people can consider for alcohol or other drug problems
Inpatient alcohol withdrawal management
Clinical processes for inpatient withdrawal management
Ambulatory/home setting management of alcohol withdrawal
Clinical process for ambulatory or home setting management of alcohol withdrawal
Substance withdrawal management
Describes appropriate processes for the management of substance withdrawal.
Medication assisted treatment for alcohol dependence
Information about medication assisted treatment for people with alcohol dependence and finding the right treatment for you.
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