Alcohol Withdrawal Syndromes

Chapter

Abstract

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.

Keywords

Pancreatitis NMDA Haloperidol Hypoglycemia Hypothyroidism 

References

  1. 1.
    Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84:1353–1357.PubMedCrossRefGoogle Scholar
  2. 2.
    Ntais C, Pakos E, Kyzas P, et al. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2005;CD005063.Google Scholar
  3. 3.
    Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997;278:144–151.PubMedCrossRefGoogle Scholar
  4. 4.
    Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish lung failure collaborative group. N Engl J Med. 1995;332:345–350.PubMedCrossRefGoogle Scholar
  5. 5.
    Spies CD, Otter HE, Huske B, et al. Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med. 2003;29:2230–2238.PubMedCrossRefGoogle Scholar
  6. 6.
    Kraus ML, Gottlieb LD, Horwitz RI, et al. Randomized clinical trial of atenolol in patients with alcohol withdrawal. N Engl J Med. 1985;313:905–909.PubMedCrossRefGoogle Scholar
  7. 7.
    Baddigam K, Russo P, Russo J, et al. Dexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients. J Intensive Care Med. 2005; 20:118–123.PubMedCrossRefGoogle Scholar
  8. 8.
    Darrouj J, Puri N, Prince E, et al. Dexmedetomidine infusion as adjunctive therapy to benzodiazepines for acute alcohol withdrawal. Ann Pharmacother. 2008;42:1703–1705.PubMedCrossRefGoogle Scholar
  9. 9.
    McCowan C, Marik P. Refractory delirium tremens treated with propofol: a case series. Crit Care Med. 2000;28:1781–1784.PubMedCrossRefGoogle Scholar
  10. 10.
    Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS Drugs. 2003;17:1013–1030.PubMedCrossRefGoogle Scholar
  11. 11.
    Polycarpou A, Papanikolaou P, Ioannidis JP, et al. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2005;CD005064.Google Scholar
  12. 12.
    Weinberg JA, Magnotti LJ, Fischer PE, et al. Comparison of intravenous ethanol versus diazepam for alcohol withdrawal prophylaxis in the trauma ICU: results of a randomized trial. J Trauma. 2008;64:99–104.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations