Withdrawal, Alcohol

Basics

Alcohol withdrawal is the most common withdrawal syndrome encountered in the emergency department
Neuroexcitation is the hallmark of alcohol withdrawal
Alcohol withdrawal may be life threatening
More severe symptoms and signs are seen in patients with prior episodes of withdrawal, a process called kindling
Alcoholism is not uncommon among older adults
Age-related increase in alcohol sensitivity
Alcohol-related problems may be misdiagnosed as normal consequences of aging

Chronic alcohol use downregulates GABA (inhibitory) receptors, upregulates NMDA (excitatory) receptors
Abstinence or reduction in use leads to increased adrenergic activity because of these receptor adaptations
4 components to alcohol withdrawal:
- Early withdrawal
- Withdrawal seizures
- Alcoholic hallucinosis
- Delirium tremens (DTs)
DTs occur in 5% of patients experiencing alcohol withdrawal
DTs have a 5–15% mortality rate

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