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FACTS - Alcohol Withdrawal

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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.


- 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).


- 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.


Institute of Alcohol Studies’ factsheets

Alcohol Concern

Royal College of Psychiatrists

National Alcohol Harm Reduction Strategy

Further reading

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

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