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Withdrawal, Alcohol

Withdrawal, Alcohol is a topic covered in the 5-Minute Emergency Consult.

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  • 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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Rosen, Peter, et al., editors. "Withdrawal, Alcohol." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307348/all/Withdrawal__Alcohol.
Withdrawal, Alcohol. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307348/all/Withdrawal__Alcohol. Accessed April 24, 2019.
Withdrawal, Alcohol. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307348/all/Withdrawal__Alcohol
Withdrawal, Alcohol [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307348/all/Withdrawal__Alcohol.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Withdrawal, Alcohol ID - 307348 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307348/all/Withdrawal__Alcohol PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -