Alcohol Withdrawal Syndromes

Introduction

Alcohol withdrawal syndromes occur following sudden withdrawal from alcohol.
They are often seen 12 to 18 hours after the last drink, but may be earlier and are worst between 24 to 48 hours after onset.
This commonly occurs in patients admitted to hospital for other problems e.g. arising from accidents or physical illnesses, which keeps them from drinking.
The presentation varies from minimal tremors to states of full-blown agitation and confusion, which are potentially fatal.

Causes of Alcohol withdrawal syndromes

Alcohol withdrawal syndromes is caused by abrupt cessation or significant reduction in alcohol intake in an individual with heavy drinking over many months or years

Onset of alcohol withdrawal syndromes

1. Minor Withdrawal

  • 12 to 18 hours after last drink, but may be earlier. Peaks between 24-48 hours

2. Alcoholic Hallucinosis

  • 12-24 hrs after cessation of drinking and generally stops within 48 hours

3. Alcoholic Seizures

  • 7-36 hours after the last drink but may be earlier.

Symptoms of alcohol withdrawal syndromes

1. Symptoms of minor Withdrawal

  1. Shaky hands
  2. Headaches
  3. Insomnia
  4. Mild anxiety
  5. Nausea
  6. Vomiting
  7. Sweating

2.  Alcoholic Hallucinosis

  1. Sensation of objects crawling on body
  2. “Seeing” objects not really present
  3. “Hearing” noises or voices nobody else can hear.

3. Alcoholic Seizures 

  • sudden generalised seizures in a chronic alcoholic

Treatment for Alcohol withdrawal syndromes

Treatment Objectives

The following are the treatment objectives of alcohol withdrawal syndromes

  1. To stabilise pulse and blood pressure
  2. To prevent dehydration
  3. To treat presenting conditions like malaria etc.
  4. To relieve pain, tremors and seizures
  5. To stop hallucinations.

Non-pharmacological treatment

  • Sit or lie in a quiet place
  • Physical restraints may be required temporarily for very agitated patients
  • Encourage intake of fluids as can be tolerated to prevent dehydration

Pharmacological treatment

1st Line Treatment
Evidence Rating [A]
Haloperidol, oral/IM,
Adults: 5 mg 8 hourly as required until hallucinations cease.
Children: Refer to specialist

Or

Olanzapine, oral,
Adults: 5-10 mg 24 hourly (max. of 10 mg 12 hourly)
Children:

  • > 12 years; 2.5-5 mg stat. Then may be increased up to 10 mg (max. 5 mg 12 hourly)

Referral Criteria

Refer all patients with alcohol withdrawal syndromes to a psychologist or psychiatrist.
Also refer all children to a paediatrician.