Withdrawal states - alcohol abuse

Withdrawal state F10.3

A group of symptoms of variable clustering and severity occurring on absolute or relative withdrawal of a psychoactive substance after persistent use of that substance. The onset and course of the withdrawal state are time-limited and are related to the type of psychoactive substance and dose being used immediately before cessation or reduction of use. The withdrawal state may be complicated by convulsions.

Minor withdrawal

  • 6-36 hours after last drink
  • tremor, insomnia anxiety, palpitation, sweating, GI upset, headache
  • lasts typically 1-2 days

Withdrawal seizures

  • after 6-48 hours after last drink, are generally tonic-clonic seizures and single episodes

Alcoholic hallucinations

  • 12-48 hours after last drink
  • consciousness is intact, normal vitals but auditory and/or visual hallucinations (also tactile possible), delusions
  • for 1-2 days

Delirium tremens

  • 2-3 days after the last drop of alcohol
  • features of delirium (changes in conciousness, hallucinations) + autonomic instability (tachycardia, HT, anxiety, nausea, sweating), seizures, psychomotor agitation, tremor...
  • visual and tactile hallucinations (mice, crawling insections)
  • can last 1-5 days

Treatment

  • IV fluid therapy, electrolyte correction
  • Thiamine for wernicke encephalopathy prophylaxis or treatment
  • dextrose (sugars!!)
  • other vitamins: folate, multivitamins)
  • IV benzos for seizures and psychomotor agitation
    • long acting or short acting (the latter (LOR) for liver patients)
  • others if indicated: anticonvulsants, antipsychotics