From the Guidelines
Alcohol withdrawal can be fatal due to severe complications like delirium tremens, seizures, and autonomic instability, and medical treatment is essential to prevent these life-threatening symptoms. When someone who regularly consumes large amounts of alcohol suddenly stops drinking, their body, which has adapted to alcohol's depressant effects, experiences dangerous hyperactivity of the nervous system, as noted in the 2018 EASL clinical practice guidelines for the management of alcohol-related liver disease 1. This can lead to life-threatening symptoms including severe confusion, hallucinations, high fever, extreme hypertension, tachycardia, and grand mal seizures.
According to the guidelines, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) score is useful in clinical practice to assess the severity of alcohol withdrawal syndrome (AWS), with a score >8 indicating moderate AWS and a score ≥15 indicating severe AWS 1. The guidelines recommend pharmacological treatment for both moderate and severe AWS using a symptom-triggered regimen, with benzodiazepines considered the 'gold standard' treatment for AWS due to their efficacy in reducing withdrawal symptoms and the risk of seizures and/or delirium tremens 1.
The treatment typically includes benzodiazepines like diazepam, lorazepam, or chlordiazepoxide, with dosing adjusted based on symptom severity, as well as supportive care including IV fluids, thiamine, folate, and electrolyte replacement. It is crucial to seek immediate medical attention rather than attempting to manage withdrawal at home, as proper medical supervision significantly reduces mortality risk from what would otherwise be a significant death rate for severe cases, highlighting the importance of timely and appropriate medical intervention in preventing fatal outcomes from alcohol withdrawal 1.
From the Research
Alcohol Withdrawal Syndrome
Alcohol withdrawal syndrome occurs when individuals who are physically dependent on alcohol stop drinking, leading to a range of symptoms that can be fatal in severe cases 2, 3, 4, 5, 6.
Symptoms and Risk Factors
The symptoms of alcohol withdrawal syndrome can vary in severity, ranging from mild "hangover" to fatal delirium tremens (DTs) 4. The main risk factors for severe withdrawal syndrome include:
- Chronic heavy drinking
- A history of generalized seizures
- A history of delirium tremens 2 Other symptoms and signs of a severe withdrawal syndrome include:
- Anxiety
- Agitation
- Tremor
- Excessive sweating
- Altered consciousness
- Hallucinations 2
Fatal Complications
If left untreated or inadequately treated, alcohol withdrawal can progress to generalized tonic-clonic seizures, delirium tremens, and death 5. Delirium tremens can result in death due to:
- Malignant arrhythmia
- Respiratory arrest
- Sepsis
- Severe electrolyte disturbance
- Prolonged seizures and subsequent trauma 3
Treatment and Management
The mainstay of treatment for alcohol withdrawal is benzodiazepine pharmacotherapy, which can be used to control mild early symptoms, prevent progression to DTs, or treat DTs itself 4. Other treatment options include: