Yes, Alcohol Withdrawal Causes These Symptoms
Alcohol withdrawal syndrome directly causes anxiety, paranoia, vomiting, and tachycardia through autonomic nervous system overactivity that begins 6-24 hours after the last drink. 1, 2
Clinical Presentation and Timeline
Anxiety and autonomic hyperactivity (including tachycardia) are hallmark features of alcohol withdrawal syndrome, occurring within 6-24 hours after cessation and representing overactivity of the central and autonomic nervous systems 1, 3
Vomiting is a common gastrointestinal manifestation of the autonomic instability that characterizes alcohol withdrawal 1, 2
Paranoia occurs as part of the spectrum of severe alcohol withdrawal complications, particularly when withdrawal progresses toward delirium tremens 4, 5
Symptom Progression and Severity
Symptoms typically peak at 3-5 days after cessation and generally resolve spontaneously within one week 1, 6
The presence of anxiety, agitation, vomiting, and tachycardia indicates at minimum moderate alcohol withdrawal syndrome requiring treatment 1, 2
More severe manifestations can include hallucinations, seizures, and delirium tremens (which begins 48-72 hours after cessation and includes confusion, paranoia, and hallucinations) 1, 5, 7
Critical Assessment Points
Vital signs monitoring is essential to assess the degree of autonomic instability—look specifically for tachycardia, hypertension, fever, and excessive sweating 1, 2
CIWA-Ar scores >8 indicate moderate withdrawal requiring treatment, while scores ≥15 indicate severe withdrawal 2
Evaluate for dangerous complications including dehydration, electrolyte imbalance (especially magnesium), infection, gastrointestinal bleeding, pancreatitis, hepatic encephalopathy, and renal failure 1, 2
Immediate Management Priorities
Benzodiazepines are first-line therapy for moderate to severe symptoms—they are the only proven treatment to prevent seizures and reduce mortality from delirium tremens 1, 2, 6
Thiamine 100-300 mg/day must be administered BEFORE any glucose-containing IV fluids to prevent precipitating acute Wernicke encephalopathy 1, 2, 8
For moderate to severe withdrawal: initiate chlordiazepoxide 50-100 mg orally, followed by 25-100 mg every 4-6 hours as needed (maximum 300 mg in first 24 hours), or diazepam 10 mg orally 3-4 times daily 1, 2, 8
In patients with hepatic dysfunction, elderly patients, or respiratory compromise, switch to lorazepam 6-12 mg/day instead of long-acting agents 1, 2, 8