Alcohol withdrawal

Alcohol withdrawal

1. Alcohol withdrawal

2. Alcohol withdrawal (NICE Pathways 2015) Someone who has been drinking alcohol heavily for a considerable period of time (i.e. several days), or has been drinking heavily and then ‘topped up’ over a period of time without respite, is in danger of alcohol withdrawal syndrome when their blood alcohol returns to minimum level. Alcohol withdrawal syndrome is a life-threatening condition. Immediate care is required for someone who is likely to experience seizures or delirium tremens. Anyone at high or medium risk should be assessed in A&E. High risk individuals and those under 16 years should be admitted to hospital.

3. Alcohol withdrawal symptoms (Guys & St. Thomas’ NHS Foundation Trust (2012) Symptoms and Signs of alcohol withdrawal syndrome can be: Anxiety Agitation Irritability Nausea Vomiting Diarrhoea Convulsions Absence of any of these does not exclude withdrawal symptoms. Tremor of hands, tongue, eyelids Insomnia Hallucinations Sweating Fever with or without infection Delirium Tachycardia Hypertension

4. Alcohol withdrawal syndrome (Guys & St. Thomas NHS Foundation Trust (2012) Symptoms will present within 6 – 8 hours of the last drink. These include epileptiform seizures within 12 to 48 hours of alcohol cessation Fits are rare beyond 48 hours following alcohol cessation. People with known alcohol dependency should also be given prophylactic vitamin B supplement ( Pabrinex ) Alcohol related seizures

5. Alcohol withdrawal symptoms (Guys & St. Thomas’ NHS Foundation Trust (2012) Delirium tremens (DTs) occurs in about 5% of patients undergoing alcohol withdrawal. Untreated, DTs is fatal in 15-20% of patients whilst early detection and prompt initiation of treatment usually prevents onset. Onset of DTs is 2-5 days (most commonly at 2-3 days) following cessation and represents a medical emergency. If untreated, death may result from respiratory and cardiovascular collapse or cardiac arrhythmias. Patients most at risk are those with a high fever (>104°F/39.9°C), tachycardia, dehydration and an associated illness (e.g. pneumonia or pancreatitis), general debility or where the diagnosis is delayed. Delirium tremens (DTs )

6. Alcohol withdrawal symptoms (Guys & St. Thomas’ NHS Foundation Trust (2012) Delirium tremens (DTs) symptoms Severe tremor Clouding of consciousness Delusions Confusion and disorientation Tachycardia Agitation or violent behaviour Delirium Fever, with or without infection: temperature > 101°F/38.3°C Severe hallucinations, often evoke extreme fear (mainly visual, may be tactile or auditory)

7. Immediate management of alcohol withdrawal syndrome (NICE Pathways 2015) Alcohol withdrawal syndrome is commonly managed in hospital through a reducing dose of benzodiazepines (diazepam or chlordiazepoxide ). Clormethiazole may be prescribed for admitted inpatients. Delirium tremens should be treated firstly with a quick-acting benzodiazepine ( lorazepam ) and psychotic symptoms should be managed with haloperidol or olanzapine . Symptoms should be observed and recorded to determine the effectiveness of the treatment.

8. References Guys and St Thomas NHS Foundation Trust (2012) Clinical Guideline, DTC Reference 10052a. NICE Pathways (2015) Acute alcohol withdrawal. Accessed 28.7.15. Available at: http://pathways.nice.org.uk/pathways/alcohol-use-disorders/acute-alcohol-withdrawal