Alcohol withdrawal involves:
Neuroadaptation: Chronic alcohol use leads to neuroadaptation in the brain, causing tolerance and dependence on alcohol.
CNS Hyperexcitability: Abrupt cessation of alcohol intake results in CNS hyperexcitability due to decreased inhibitory neurotransmission (GABA) and increased excitatory neurotransmission (glutamate).
Withdrawal Syndrome: Manifests as a spectrum of symptoms ranging from mild anxiety and tremors to severe agitation, hallucinations (alcoholic hallucinosis), seizures (alcohol withdrawal seizures), and delirium tremens (DTs).
Complications: Severe withdrawal symptoms, particularly DTs, can lead to cardiovascular instability, metabolic disturbances, and death if untreated.
Clinical Evaluation
Symptoms: Assessment of symptoms such as anxiety, agitation, tremors, insomnia, hallucinations (visual or auditory), and seizures.
Physical Examination: Examination findings may include elevated heart rate, blood pressure fluctuations, hyperthermia, diaphoresis, and signs of autonomic instability.
Diagnostic Tests: Clinical assessment based on DSM-5 criteria for alcohol withdrawal syndrome, assessment of severity using validated scales (CIWA-Ar), and laboratory tests to assess electrolyte imbalances and liver function.
Mild to severe anxiety, restlessness, and irritability.
Tremors (especially in the hands), sweating, and palpitations.
Hallucinations, typically visual (seeing things that are not present).
Seizures, usually generalized tonic-clonic seizures (alcohol withdrawal seizures).
Delirium tremens (DTs), characterized by severe agitation, hallucinations, disorientation, and autonomic instability.
Management focuses on symptom relief, prevention of complications, and supportive care:
Medications: Benzodiazepines (e.g., diazepam, lorazepam) to reduce CNS hyperexcitability and prevent seizures and DTs.
Supportive Care: Monitoring vital signs, fluid and electrolyte balance, and nutritional support.
Psychosocial Support: Counseling, support groups, and behavioral therapies to address alcohol dependence and prevent relapse.
Medical Supervision: Inpatient care for severe withdrawal syndromes (e.g., DTs) requiring intensive monitoring and management.