Alcohol Withdrawal Syndrome

Excerpt

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol is the most commonly used substance in the United States, with over 75% of individuals aged 12 and older reporting lifetime consumption. Alcohol consumption spans a spectrum ranging from low risk to severe alcohol use disorder (AUD). Chronic risky drinking or the presence of AUD increases the risk of alcohol withdrawal syndrome. Alcohol withdrawal syndrome poses a significant clinical challenge arising from the spectrum of AUD—a prevalent condition affecting a substantial portion of the United States population.

Although most cases of alcohol withdrawal syndrome are mild and do not necessitate medical intervention, severe presentations can lead to life-threatening complications and require urgent intervention across multiple healthcare settings. Treatment can occur in various settings, such as the emergency room, outpatient clinic, intensive care unit, or detoxification facility. Consequently, the interprofessional healthcare team must ascertain the most suitable setting based on a patient’s symptoms.

Following alcohol cessation, alcohol withdrawal syndrome typically presents as minor symptoms such as mild anxiety, headache, gastrointestinal discomfort, and insomnia. This syndrome can further progress to severe manifestations, such as alcohol withdrawal delirium, which poses significant diagnostic and management challenges. Mild symptoms may progress to alcohol hallucinosis, characterized by visual or auditory hallucinations that usually subside within 48 hours after alcohol cessation. Withdrawal seizures can occur in patients within just a few hours of alcohol cessation.

Alcohol withdrawal delirium, formerly known as delirium tremens, is the most severe manifestation of alcohol withdrawal syndrome, characterized by symptoms such as fever, tachycardia, agitation, diaphoresis, hallucinations, disorientation, and hypertension. Patients are at risk of experiencing alcohol withdrawal delirium anywhere from 3 to 8 days following alcohol cessation. While only approximately 3% to 5% of patients with alcohol withdrawal syndrome will progress to alcohol withdrawal delirium, this condition may prove fatal. Identifying patients at risk for alcohol withdrawal delirium through a validated tool and considering the patient’s history of complicated withdrawal is a crucial aspect of managing the syndrome.