From the Guidelines
Laboratory tests for diagnosing Alcohol Withdrawal Syndrome (AWS) include a comprehensive metabolic panel, electrolyte levels, complete blood count, blood alcohol concentration, and toxicology screening, as well as assessments for hypoglycemia, hypophosphatemia, and nutritional deficiencies, with the Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) being a crucial tool for evaluating withdrawal severity 1. The diagnosis of AWS is primarily clinical, relying on the identification of symptoms and signs associated with alcohol withdrawal, but laboratory tests play a crucial role in supporting the diagnosis and guiding management. Key laboratory tests include:
- Comprehensive metabolic panel to assess liver function, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT) 1
- Electrolyte levels, particularly sodium, potassium, and magnesium, to identify abnormalities that may require specific replacement protocols
- Complete blood count to check for anemia or infection
- Blood alcohol concentration to determine current intoxication levels
- Toxicology screening to identify other substances that may be contributing to the patient's condition Additional important tests include:
- Blood glucose measurement to detect hypoglycemia, which can mimic or exacerbate withdrawal symptoms
- Phosphate levels, as hypophosphatemia can occur during withdrawal
- Urine analysis and coagulation studies (PT/INR) to assess for other complications
- Thiamine levels, as many patients with alcohol use disorder have nutritional deficiencies These laboratory assessments complement the clinical evaluation using standardized tools like the CIWA-Ar, which remains the cornerstone for diagnosing and monitoring withdrawal severity 1. The CIWA-Ar score can help guide treatment decisions, with scores >8 indicating moderate AWS and scores ≥15 indicating severe AWS.
From the Research
Lab Tests for Diagnosing Alcohol Withdrawal Syndrome (AWS)
The following lab tests are used to diagnose and assess the severity of Alcohol Withdrawal Syndrome (AWS):
- Liver function tests, such as measures of alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase 2
- Measurements of albumin, bilirubin, prothrombin time, and blood urea nitrogen to indicate impaired hepatic function 2
- Electrolyte tests, including measurements of magnesium, phosphate, and acid-base balance 2
- Hematologic function tests, including complete blood counts and measurements of hemoglobin, mean corpuscular volume, white blood cell count, and platelets 2, 3
- Creatine phosphokinase (CPK) levels, which have been shown to be positively correlated with the severity of AWS 3
- Measurements of serum potassium and magnesium levels, which may be decreased in patients with AWS 3
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, which may be elevated in patients with AWS 3
Assessment Tools
In addition to lab tests, the following assessment tools are used to diagnose and assess the severity of AWS: