By continuing to use the site you agree to our Privacy & Cookies policy

FACTS - Alcohol Withdrawal

AETIOLOGY AND RISK FACTORS

Abstract

 

VOL: 99, ISSUE: 23, PAGE NO: 31

 

 

AETIOLOGY AND RISK FACTORS

 


 

- Physical dependence upon alcohol results in withdrawal symptoms if alcohol intake is suddenly stopped or reduced sharply.

 


 

- Withdrawal symptoms commence within 12 hours of stopping alcohol; these can be unpleasant even in their most minor forms.

 


 

- Most dependent drinkers will experience the minor forms of withdrawal, while some will suffer severe symptoms that require detoxification in an inpatient setting.

 


 

- Risks can include dehydration from vomiting or diarrhoea, convulsions, hallucinations and or confusion, leading to agitation and sometimes aggression.

 


 

- Minor withdrawal symptoms often peak between the second and fourth days of withdrawal and subside after this, disappearing by the eighth to tenth day.

 


 

- Major withdrawal symptoms can appear between the first and fifth days, with rapid onset. A previous history of these symptoms is the best predictor of their recurrence.

 


 

SIGNS AND SYMPTOMS

 


 

- The quantity of alcohol consumed does not necessarily dictate the severity of symptoms.

 


 

Minor symptoms

 


 

- Trembling;

 


 

- Agitation or anxiety;

 


 

- Insomnia;

 


 

- Morning retching or vomiting;

 


 

- Sweating, particularly at night;

 


 

- Frequent loose bowel motions.

 


 

Major symptoms

 


 

- Withdrawal convulsions;

 


 

- Hallucinations;

 


 

- Confusion, possible Wernicke’s encephalopathy or Korsakoff’s psychosis;

 


 

- Delirium tremens - a serious effect of withdrawal displaying many of the above symptoms, including sweating, tachycardia, tachypnoea and pyrexia. It may also include dehydration, concurrent infection, hepatic disease or Wernicke-Korsakoff syndrome. The patient is often disorientated, with agitation, marked tremor and vivid hallucinations. The condition can be fatal if untreated.

 


 

DIAGNOSIS

 


 

- The international criteria for psychiatric diagnosis classifies alcohol withdrawal as ICD-10 (F10.3). The number 10 indicates mental illness, F10 relates to mental disorders due to alcohol, and F10.3 refers to the withdrawal state.

 


 

- The ICD states that any three of the listed symptoms are useful in making a diagnosis of alcohol dependence, in conjunction with a verbal history from the patient or relatives, a previous medical history, high blood alcohol, alcohol on the breath and deranged liver function tests (LFTs).

 


 

TREATMENT

 


 

- Sedation with appropriate benzodiazepines (often chlordiazepoxide). The regimen should dampen symptoms while avoiding over sedation and should be reduced to zero over eight to 10 days.

 


 

- Management of hallucinations with suitable neuroleptics.

 


 

- Maintenance of hydration.

 


 

- Vitamin treatment of dietary neglect, and as prophylaxis, to prevent Wernicke-Korsakoff syndrome. Where confusion is present, or if there is a history of dietary neglect, vitamins are given parenterally.

 


 

- Treatment of concurrent infections.

 


 

NURSING IMPLICATIONS

 


 

- The observation of symptoms and titration of medication accordingly (in collaboration with medical staff).

 


 

- Administration of parenteral vitamins and intravenous medications and fluids, particularly if delirium tremens is present.

 


 

- Management of confusion or hallucinations, orientation via explanation, liaison with specialist services and psychiatry regarding treatment and follow-up options.

 


 

WEBSITES

 


 

 


 

 


 

 


 

 


 

FURTHER READING

 


 

Royal College of Physicians (2001) Alcohol - Can the NHS Afford it? Recommendations for a coherent alcohol strategy for hospitals. London: RCP.

Have your say

You must sign in to make a comment.

Related images

Related Jobs

Sign in to see the latest jobs relevant to you!

newsletterpromo