Approximately 11–15 million people report heavy alcohol use or alcohol abuse and dependence in the United States; not surprisingly, alcohol-related medical problems are commonly encountered in critically ill and injured patients. Alcohol withdrawal syndrome (AWS) consists of symptoms and signs arising in alcohol-dependent individuals, typically within 24–48 h of consumption of their last drink. Delirium tremens (DTs), a severe and potentially fatal form of AWS, typically occurs 48–96 h after withdrawal of alcohol. AWS is usually mild and self–limiting; however, approximately 5% of patients develop DTs with a mortality approaching 15%. Older age, underlying disease, and comorbid liver disease are associated with an increased mortality risk. Although AWS occurs intentionally in those seeking abstinence, it may arise unexpectedly in an alcohol-dependent patients after admission to hospital. This disorder usually manifests itself on hospital days 3–5 and usually lasts less than 1 week although prolonged DTs has been described.
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