From the Guidelines
Alcohol withdrawal symptoms occur when someone who regularly drinks heavily suddenly stops or significantly reduces their alcohol intake, and common symptoms include tremors, anxiety, irritability, nausea, vomiting, headache, insomnia, sweating, and increased heart rate, as noted in the most recent study by Louvet et al. 1. The symptoms of Alcohol Withdrawal Syndrome (AWS) can range from mild to severe and may include:
- Autonomic nervous system activation such as tachycardia, sweating, and hand tremor
- Gastrointestinal symptoms such as nausea and vomiting
- Deficits in cognitive function such as hallucinations, seizures, and withdrawal delirium that may lead to death, as described in the study by kasl clinical practice guidelines 1
- Delirium tremens, a serious complication of AWS, characterized by altered mental status, disorientation to person, place, or time, and intra- and inter-daily variations of symptoms, as noted in the study by easl clinical practice guidelines 1
- Other symptoms such as increased blood pressure and pulse rate, hyperreflexia, irritability, anxiety, headache, and coma, as mentioned in the study by easl clinical practice guidelines 1 The management of AWS should prioritize symptomatic relief without complications and maintenance of abstinence as a long-term treatment, with benzodiazepines being the 'gold standard' treatment for AWS, as recommended by the french association for the study of the liver and the french alcohol society clinical guidelines 1. The treatment of AWS may include:
- Benzodiazepines, such as diazepam or lorazepam, to reduce withdrawal symptoms and prevent seizures and delirium tremens
- Thiamine, to prevent Wernicke-Korsakoff syndrome, as recommended by the french association for the study of the liver and the french alcohol society clinical guidelines 1
- Regular monitoring to guide dosage adjustment and prevent seizures, as noted in the study by Addolorato et al. 1 It is essential to note that the treatment of AWS should be personalized and adapted to the individual's symptoms and medical history, as recommended by the french association for the study of the liver and the french alcohol society clinical guidelines 1.
From the Research
Symptoms of Alcohol Withdrawal Syndrome
The symptoms of Alcohol Withdrawal Syndrome can be categorized into mild, moderate, and severe. Some common symptoms include:
- Autonomic hyperactivity
- Tremor
- Nausea or vomiting
- Hallucinations
- Psychomotor agitation
- Anxiety
- Grand mal seizures
- Insomnia
- Excessive sweating
- Altered consciousness
- Delirium tremens 2, 3, 4, 5, 6
Severe Symptoms
Severe symptoms of Alcohol Withdrawal Syndrome may include:
- Generalized tonic-clonic seizures
- Delirium tremens
- Hallucinations
- Agitation
- Excessive sweating
- Altered consciousness 3, 4, 5, 6
Assessment and Diagnosis
The diagnosis of Alcohol Withdrawal Syndrome is based on the patient's history, physical examination, and laboratory tests. The Clinical Institute Withdrawal Assessment Scale-Alcohol Revised (CIWA-Ar) is a commonly used scale to assess the severity of withdrawal symptoms 3, 5.
Risk Factors for Severe Withdrawal Syndrome
The main risk factors for severe withdrawal syndrome include:
- Chronic heavy drinking
- History of generalized seizures
- History of delirium tremens 4