Alcohol withdrawal overview

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Alcohol Withdrawal Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Alcohol withdrawal from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Alcohol Withdrawal Calculator

History and Symptoms

Physical Examination

Laboratory Findings

CT

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2] Aditya Govindavarjhulla, M.B.B.S. [3]

Overview

Alcohol withdrawal refers to symptoms that can occur when a person who has been drinking alcohol every day suddenly stops drinking alcohol.


Overview

Historical Perspective

Classification

Stages of Alcohol Withdrawal Syndrome (AWS) may be classified as:[1]

  • Uncomplicated withdrawal (first 6 hours)
  • Alcohol hallucinosis  (8-12 hours)
  • Alcohol withdrawal seizures (12-24 hours)
  • Alcohol withdrawal delirium (24-72 hours)

Pathophysiology

Causes

Alcohol withdrawal occurs with sudden discontinuation of alcohol intake after consumption of large quantities of alcohol for more than two weeks.[2]

Differentiating Alcohol Withdrawal from Other Diseases

Alcohol withdrawal must also be differentiated from other diseases that cause seizures, personality changes, altered level of consciousness and hand tremors (asterixis). The differentials include the following:[3][4][5][6][7][8][9][10][11][12][13][14]

Epidemiology and Demographics

Risk Factors

Risk factors for alcohol withdrawal include:[14]

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

The most common symptoms of alcohol withdrawal include:[15]

The most severe symptoms in alcohol withdrawal include [15]

Physical Examination

Signs to consider in the physical examination of patients with alcohol withdrawal may include:[1]

Laboratory Findings

Routine laboratory tests should include:[16]

CT scan

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

References

  1. 1.0 1.1 Wolf C, Curry A, Nacht J, Simpson SA (2020). "Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives". Open Access Emerg Med. 12: 53–65. doi:10.2147/OAEM.S235288. PMC 7093658 Check |pmc= value (help). PMID 32256131 Check |pmid= value (help).
  2. Muncie HL, Yasinian Y, Oge' L (2013). "Outpatient management of alcohol withdrawal syndrome". Am Fam Physician. 88 (9): 589–95. PMID 24364635.
  3. Meparidze MM, Kodua TE, Lashkhi KS (2010). "[Speech impairment predisposes to cognitive deterioration in hepatic encephalopathy]". Georgian Med News (181): 43–9. PMID 20495225.
  4. Kattimani S, Bharadwaj B (2013). "Clinical management of alcohol withdrawal: A systematic review". Ind Psychiatry J. 22 (2): 100–8. doi:10.4103/0972-6748.132914. PMC 4085800. PMID 25013309.
  5. Roldán J, Frauca C, Dueñas A (2003). "[Alcohol intoxication]". An Sist Sanit Navar. 26 Suppl 1: 129–39. PMID 12813481.
  6. Seifter JL, Samuels MA (2011). "Uremic encephalopathy and other brain disorders associated with renal failure". Semin Neurol. 31 (2): 139–43. doi:10.1055/s-0031-1277984. PMID 21590619.
  7. Handler CE, Perkin GD (1983). "Wernicke's encephalopathy". J R Soc Med. 76 (5): 339–42. PMC 1439130. PMID 6864698.
  8. Kim Y, Kim JW (2012). "Toxic encephalopathy". Saf Health Work. 3 (4): 243–56. doi:10.5491/SHAW.2012.3.4.243. PMC 3521923. PMID 23251840.
  9. Hartmann A, Buttinger C, Rommel T, Czernicki Z, Trtinjiak F (1989). "Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbondioxide-reactivity by hypotensive agents in baboons with intracranial hypertension". Neurochirurgia (Stuttg). 32 (2): 37–43. doi:10.1055/s-2008-1053998. PMID 2497395.
  10. Kumar N (2011). "Acute and subacute encephalopathies: deficiency states (nutritional)". Semin Neurol. 31 (2): 169–83. doi:10.1055/s-0031-1277986. PMID 21590622.
  11. Chiu GS, Chatterjee D, Darmody PT, Walsh JP, Meling DD, Johnson RW; et al. (2012). "Hypoxia/reoxygenation impairs memory formation via adenosine-dependent activation of caspase 1". J Neurosci. 32 (40): 13945–55. doi:10.1523/JNEUROSCI.0704-12.2012. PMC 3476834. PMID 23035103.
  12. Peate I (2004). "An overview of meningitis: signs, symptoms, treatment and support". Br J Nurs. 13 (13): 796–801. doi:10.12968/bjon.2004.13.13.13501. PMID 15284663.
  13. Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ (2015). "Hypoglycemia in older people - a less well recognized risk factor for frailty". Aging Dis. 6 (2): 156–67. doi:10.14336/AD.2014.0330. PMC 4365959. PMID 25821643.
  14. 14.0 14.1 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  15. 15.0 15.1 Saitz R (1998). "Introduction to alcohol withdrawal". Alcohol Health Res World. 22 (1): 5–12. PMC 6761824 Check |pmc= value (help). PMID 15706727.
  16. Mirijello A, D'Angelo C, Ferrulli A, Vassallo G, Antonelli M, Caputo F; et al. (2015). "Identification and management of alcohol withdrawal syndrome". Drugs. 75 (4): 353–65. doi:10.1007/s40265-015-0358-1. PMC 4978420. PMID 25666543.
  17. Maes M, Vandoolaeghe E, Degroote J, Altamura C, Roels C, Hermans P (2000). "Linear CT-scan measurements in alcohol-dependent patients with and without delirium tremens". Alcohol. 20 (2): 117–23. doi:10.1016/s0741-8329(99)00066-x. PMID 10719790.
  18. Bleich S, Sperling W, Degner D, Graesel E, Bleich K, Wilhelm J; et al. (2003). "Lack of association between hippocampal volume reduction and first-onset alcohol withdrawal seizure. A volumetric MRI study". Alcohol Alcohol. 38 (1): 40–4. doi:10.1093/alcalc/agg017. PMID 12554606.