Withdrawal, Alcohol

Basics

Description

  • 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
  • Alcohol use, alcohol use disorder, and alcohol withdrawal have increased over the last decade, especially since the COVID-19 pandemic

Etiology

  • 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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