Withdrawal state in alcohol addiction and its treatment

Alcohol withdrawal state or withdrawal syndrome, occurs mainly in people with long-term and intensive abuse of alcohol. It can range from uncomplicated withdrawal symptoms to a life-threatening condition – delirium tremens. It develops within "6-48 hours" after stopping or substantially reducing alcohol intake.

Symptoms of uncomplicated alcohol withdrawal

 * Tremor (most often hands), increased sweating, tachycardia, increased blood pressure, anxiety, inner restlessness, irritability, malaise or weakness, paresthesia of limbs, nausea, vomiting, sleep disorders, terrifying dreams, fleeting hallucinations.
 * Wears off within 3–5 days.

Alcohol withdrawal therapy

 * mode measures – rest mode, removal of redundant stimuli, quiet semi-dark room, blood pressure and pulse monitoring,
 * benzodiazepines, tiapride, clomethiazole in capsules for severe courses (only during hospitalization), thiamin, magnesium,
 * sufficient hydratation and ensuring electrolyte balance.

Complications of alcohol withdrawal

 * Epileptic seizures – the drug of choice is benzodiazepines, especially diazepame; then MgSO4 10% or 20% in intravenous or intramuscular administration.
 * Progression to delirium.

Delirium tremens
This is the most severe form of withdrawal syndrome. It develops in 5–6 % of alcohol addicts, typically in the 2.–3. day of abstinence. Sometimes it starts already when intoxication is fading, rarely even during a drinking binge (intoxication delirium). Mortality was previously reported to be 5–10 %, according to more recent studies it does not exceed 1 %.

Set of symptoms of a delirious state

 * 1) Mental: great psychomotor restlessness with agitation, disorders of consciousness with confusion, temporal and spatial disorientation, visual or tactile hallucinations, sleep disorders (often inversion), incoherent thinking, emotional detachment, fear, anxiety.
 * 2) Somatic and vegetative: tachycardia, increased blood pressure, fever, rapid breathing, disorders of the internal environment (dehydration, electrolyte imbalance), dilated pupils, conjunctival congestion, incontinence.
 * 3) Neurological: tremors (fingers, sometimes even entire limb, head), ataxia, hyperkinesia, hyperreflexia, epileptic paroxysms.

Therapy of the delirious state

 * Soothing of acute restlessness: clomethiazole (Heminevrin), in doses up to 4,8 g/day, is contraindicated in bronchopulmonary involvement, in which case antipsychotics are recommended (risperidone, tiapride), then benzodiazepines.
 * Adjustment and maintenance of homeostasis of the internal environment: replenish fluids and minerals, administer MgSO4, group B vitamins, glucose.
 * Prevence a léčba somatických komplikací: nejčastěji poruchy jaterních funkcí, pneumonie, krvácení do GIT, aj.

Related articles

 * Mental disorders caused by alcohol consumption
 * Alcohol addiction treatment