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Alcohol withdrawal state Causes and Risks:
Alcohol withdrawal state occurs in approximately 1 out of 10,000 people, usually adults. It occurs when a person who uses alcohol excessively suddenly stops the alcohol use , usually within 12 to 72 hours after the last drink. Excessive alcohol use is generally considered intake equivalent to 7 to 8 pints of beer (or 1 pint of "hard" alcohol) per day for several months or habitual use of alcohol or alcoholism that has existed for more than 10 years.
The symptoms result from nervous system toxicity caused by alcohol and can range from mild to moderate ( anxiety , thinking difficulty, and muscle tremors ), to severe complicated alcohol abstinence symptoms ( delirium tremens, called d.T.s and convulsions ).
Prevention:
Minimize or avoid the use of alcohol. In persons with alcoholism , total abstinence from alcohol may be necessary.
Symptoms:
Complicated alcohol abstinence symptoms:
Signs and Tests:
Examination of the neuromuscular system may show increased startle reflex, bulbous-red nose, or rapid rhythmic muscle tremors . Abnormal eye muscle movement such as lid lag may be present. The heart rate may be faster than normal (greater than 90). Body temperature may be elevated. Heart rate and body temperature may fluctuate.
A toxicology screen for blood alcohol level may be performed.
Treatment:
The goals of treatment are to treat the immediate withdrawal symptoms, to prevent complications, and to begin long-term preventive treatment.
Immediate treatment involves symptom relief, constant observation, and frequent monitoring of physical functions and condition. Hospitalization is often required. Heart function, respiratory function, and general physical condition are monitored by frequent measurements of vital signs (temperature, pulse , rate of breathing, blood pressure ) and fluids and electrolytes (chemicals in the body such as sodium and potassium).
Symptoms may progress rapidly and become an emergency condition. Central nervous system depressants and sedatives may be required, often in moderately large doses, to reduce symptoms. Treatment may require maintenance of a moderately sedated state for a week or more until withdrawal is complete. Benzodiazepine medications such as diazepam are often useful to reduce symptoms. Clonidine may reduce cardiovascular symptoms and helps reduce anxiety (this medication is commonly used for symptoms of narcotic drug withdrawal).
A "drying out" period may be appropriate. No alcohol is allowed during this time.
Monitoring for signs of complicated alcohol abstinence is ongoing, and signs are treated as appropriate.
Hallucinations that occur without other symptoms of complications are uncommon. They are treated similarly to any acute psychotic episode, with hospitalization and antipsychotic medications (such as haloperidol) as needed.
Testing and treatment for other medical problems associated with use of alcohol is necessary. This may include disorders such as alcoholic liver disease , blood clotting disorders, alcoholic neuropathy , heart disorders (such as alcoholic cardiomyopathy ), chronic brain syndromes (such as Wernicke-Korsakoff syndrome ), and malnutrition .
Treatment for alcohol use or alcoholism is often recommended. This may include psychiatric interventions, social support such as AA (Alcoholics Anonymous), medications, and behavior modification.
Support Groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See alcoholism - support group .
Prognosis:
Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition. Symptoms usually begin within 12hrs of the last drink. Acute symptoms peak in 48 to 72 hours and may persist for a week or more. Symptoms such as sleep changes, emotional lability, and fatigue may persist for 3 to 12 months and may become chronic .
Complications:
Call Your Healthcare Provider:
Call your health care provider or go the emergency room if symptoms indicate alcohol withdrawal state, especially in a person who has a history of habitual use of alcohol or a history of stopping use of alcohol after a period of heavy alcohol consumption . Alcohol withdrawal is a serious condition that may rapidly develop to an emergency condition.
Call for an appointment with your health care provider if symptoms persist after treatment.
Go to the emergency room or call the local emergency number (such as 911) if emergency symptoms occur, including seizures , fever , delirium or severe confusion , hallucinations , and irregular heart beat .
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