From the Guidelines
Alcohol withdrawal symptoms typically begin within 6-24 hours after the last drink and can range from mild to severe, including anxiety, irritability, nausea, vomiting, tremors, sweating, headache, insomnia, and increased heart rate and blood pressure, with more severe withdrawal progressing to hallucinations, seizures, and delirium tremens (DTs) 1. The symptoms of Alcohol Withdrawal Syndrome (AWS) can be categorized into mild, moderate, and severe, with the severity depending on factors such as the amount and duration of alcohol consumption, previous withdrawal experiences, and overall health. Some common symptoms of AWS include:
- Anxiety and irritability
- Nausea and vomiting
- Tremors, especially in the hands
- Sweating and headache
- Insomnia and increased heart rate and blood pressure More severe withdrawal symptoms may progress to:
- Hallucinations, usually visual
- Seizures
- Delirium tremens (DTs), which involves confusion, severe agitation, fever, and potentially life-threatening cardiovascular changes According to the most recent and highest quality study, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is a useful tool in clinical practice for evaluating the severity of AWS, with a score >8 indicating moderate AWS and a score ≥15 indicating severe AWS 1. It is essential to note that the management of AWS should prioritize the prevention of complications, such as Wernicke's encephalopathy, and the treatment of underlying medical conditions, with benzodiazepines being the 'gold standard' treatment for AWS, given their efficacy in reducing withdrawal symptoms and the risk of seizures and/or delirium tremens 1.
From the Research
Symptoms of Alcohol Withdrawal Syndrome
The symptoms of Alcohol Withdrawal Syndrome (AWS) can range from mild to severe and include:
- Tremors, insomnia, nausea and vomiting, hallucinations, anxiety, and agitation 2
- Mild "hangover" to fatal delirium tremens (DTs) 3
- Tremor, hallucinosis, and seizures usually occur within 48 hours of abstinence 3
- Delirium tremens (DTs) usually appears after 48 hours of abstinence and consists of marked inattentiveness, agitation, hallucinations, fluctuating level of alertness, marked tremulousness, and sympathetic overactivity 3
- Clouded consciousness, disorientation, disturbed circadian rhythms, thought processes and sensory disturbances, all of them fluctuating in time 4
- Autonomic hyperactivity, such as hypertension, tachycardia, and sweating 4
Severe Symptoms
Severe symptoms of AWS can include:
- Generalized tonic-clonic seizures 2
- Delirium tremens (DTs) 2, 3, 4
- Status epilepticus 3
- Malignant arrhythmia, respiratory arrest, sepsis, severe electrolyte disturbance or prolonged seizures and subsequent trauma 4
Diagnosis and Assessment
Diagnosis and assessment of AWS can be done using various tools, including: