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Alcohol Withdrawal Syndrome
Published in Charles Theisler, Adjuvant Medical Care, 2023
Alcohol withdrawal is commonly encountered in general hospital settings. Alcohol withdrawal syndrome is a set of symptoms that occur in a predictable pattern following the last drink after a period of excessive use. Symptoms typically include anxiety, shakiness, headache, sweating, vomiting, rapid heart rate, confusion, and a mild fever. Tremors (shakes) usually begin within 5–10 hours after the last alcohol drink and typically peak at 24–48 hours. The most dangerous form of alcohol withdrawal is delirium tremens. Treating alcohol withdrawal is a short-term fix that does not help the core problem. Chronic alcoholism is the seventh leading risk factor for death and disability-adjusted life-years.1
Diseases of the Nervous System
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
Alcohol withdrawal syndrome occurs in a predictable manner in chronic alcoholics and is related to the degree of preceeding alcohol intake.247,604 The withdrawal symptoms are connected with irregular tremors, severe tremulousness, disordered perception, and frank visual and auditory hallucinations. In a small percentage of patients, generalized seizures occur and alcoholic polyneuropathy develops.316 Delirium tremens constitutes a major withdrawal syndrome. Patients display confusion and extreme agitation, restlessness, and excess motor activity. In fatal cases, hyperthermia or circulatory collapse may lead to death.584.
Substance Use: Our Patients, Drugs and Alcohol
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
Alcohol withdrawal syndrome is associated with a 5–15% risk of death [32]. Alcohol withdrawal may precipitate delirium tremens, seizures may follow and death may occur from cardiac arrhythmias and respiratory failure [33]. These risks can be reduced through pharmacologically supported detox [33], but risks increase with multiple attempts to detox especially when in close succession, in a process called ‘kindling’ [34].Chris didn’t get a Librium prescription that day or for some time later. After several detoxes when he had presented with withdrawal symptoms at A&E, Chris eventually followed up on our referral to local services and engaged with counselling and a support group. He had a supervised detox in the community, seeing a support worker on alternate days. A year on from this he still hasn’t had a drink. ‘At first I didn’t want to stop drinking’, says Chris. ‘I was only doing it because other people said I had to. Once I realised I needed to do it for me, I found the motivation to push through it and I feel so much better now. My life is coming back together’. Chris is now off his thiamine but stays on Acamprosate and attends regular meeting of Alcoholics Anonymous. ‘I still think about booze a lot and the idea of never drinking again is still terrifying. That’s why I’ve promised myself a drink on my 80th birthday’, he says laughing.
Fixed-dose gabapentin augmentation in the treatment of alcohol withdrawal syndrome: a retrospective, open-label study
Published in The American Journal of Drug and Alcohol Abuse, 2020
Alex Andaluz, Dustin DeMoss, Cynthia Claassen, Somer Blair, Jennifer Hsu, Sulaimon Bakre, Mehreen Khan, Folefac Atem, A John Rush
Upwards of half a million episodes of alcohol withdrawal syndrome (AWS) per year require pharmacologic treatment in the US (1). Although these symptoms generally resolve within seven days or less, AWS can be accompanied by serious or even life-threatening symptoms. Alcohol is a gamma-aminobutyric acid – A (GABA-A) receptor positive modulator and an N-methyl-d-aspartate glutamate (NMDA) receptor negative regulator (2). An overall increase in GABA-A activity and a corresponding decrease in NMDA activity occurs when a person is acutely intoxicated. However, compensation via up-regulation of NMDA receptors occurs in response to sustained alcohol intake and increasing tolerance. This results in NMDA hyperactivity at the cessation of chronic alcohol use. NMDA hyperactivity can result in hallucinations, delirium tremors, and seizures which are sometimes life-threatening.
Evaluation of the appropriate use of a CIWA-Ar alcohol withdrawal protocol in the general hospital setting
Published in The American Journal of Drug and Alcohol Abuse, 2018
Amanda S. Eloma, Jason M. Tucciarone, Edmund M. Hayes, Brian D. Bronson
Americans have a 14% lifetime risk of alcohol use disorder (AUD) and nearly half will experience alcohol withdrawal (1). Alcohol withdrawal syndrome (AWS) occurs approximately 4 to 72 h following cessation or reduction of prolonged, heavy alcohol ingestion (2). The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) is a validated 10-item assessment tool used to quantify the severity of AWS and provide clinician guidance for benzodiazepine treatment of AWS (3,4). In practice, nurses often perform the assessment hourly and may administer symptom-triggered benzodiazepine therapy dependent on the total CIWA-Ar score (3). Typically, a CIWA-Ar protocol is initiated prophylactically during initial intake in the emergency department in patients at risk of developing AWS; though the protocol may be ordered at any point during hospitalization.
Molecular spectroscopic studies examining the interactions between phenobarbital and human serum albumin in alcohol consumption
Published in The American Journal of Drug and Alcohol Abuse, 2018
Sheng-Feng Cui, Wei Li, Cheng-He Zhou
Alcohol dependence is one of the most highly prevalent chronic disorders worldwide and is caused by the accumulation and deposition of complex interactions among environmental, genetic, and biological risk factors. This chronic disorder can lead to many serious health and social consequences, such as type 2 diabetes mellitus, gout, drunk driving, violence, attempted suicide, and illicit drug use (1). Alcohol policies in many countries have been formulated to reduce the harmful use of alcohol and alcohol-attributable burdens on health and society. Meanwhile, in recent years, studies have focused on alcohol dependence in the field of medicine, which have become an extremely attractive area. Many valuable studies (2) on the development of alcohol dependence have suggested that the major inhibitory neurotransmitter receptors, including GABAA, in the human brain are involved in acute and chronic alcohol effects, including dependence, withdrawal, sedation, ethanol preference, and lack of motor coordination. Based on evidence from clinical studies (3), the most difficult part of alcohol dependence treatment is that alcohol withdrawal syndrome occurs frequently when alcohol consumption is suddenly stopped or reduced after a period of high regular dinking. The consequences resulting from alcohol withdrawal syndrome are potentially life-threatening and are usually characterized by tachycardia, agitation and tremor and, in severe cases, memory and attention lapses, loss of coordination, and seizures (4).