Alcohol withdrawal syndrome
Alcohol withdrawal syndrome (AWS) is a set of symptoms that can occur following a reduction in alcohol use after a period of excessive use.[1] Symptoms typically include anxiety, shakiness, sweating, vomiting, fast heart rate, and a mild fever.[1] More severe symptoms may include seizures, and delirium tremens (DTs); which can be fatal in untreated patients.[1] Symptoms start at around 6 hours after last drink.[2] Peak incidence of seizures occurs at 24-36 hours[5] and peak incidence of delirium tremens is at 48-72 hours.[6]
Alcohol withdrawal syndrome
Anxiety, shakiness, sweating, vomiting, fast heart rate, mild fever[1]
Six hours following the last drink[2]
Up to a week[2]
Reduction or cessation of alcohol intake after a period of excessive use[1]
~50% of people with alcoholism upon reducing use[3]
Alcohol withdrawal may occur in those who are alcohol dependent.[1] This may occur following a planned or unplanned decrease in alcohol intake.[1] The underlying mechanism involves a decreased responsiveness of GABA receptors in the brain.[3] The withdrawal process is typically followed using the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar).[3]
The typical treatment of alcohol withdrawal is with benzodiazepines such as chlordiazepoxide or diazepam.[2] Often the amounts given are based on a person's symptoms.[2] Thiamine is recommended routinely.[2] Electrolyte problems and low blood sugar should also be treated.[2] Early treatment improves outcomes.[2]
In the Western world about 15% of people have problems with alcoholism at some point in time.[3] Alcohol depresses the central nervous system, slowing cerebral messaging and altering the way signals are sent and received. Progressively larger amounts of alcohol are needed to achieve the same physical and emotional results. The drinker eventually must consume alcohol just to avoid the physical cravings and withdrawal symptoms. About half of people with alcoholism will develop withdrawal symptoms upon reducing their use, with four percent developing severe symptoms.[3] Among those with severe symptoms up to 15% die.[2] Symptoms of alcohol withdrawal have been described at least as early as 400 BC by Hippocrates.[7][8] It is not believed to have become a widespread problem until the 1700s.[8]
Diagnosis[edit]
Many hospitals use the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol in order to assess the level of withdrawal present and therefore the amount of medication needed.[12] When overuse of alcohol is suspected but drinking history is unclear, testing for elevated values of carbohydrate-deficient transferrin or gammaglutamyl transferase can help make the diagnosis of alcohol overuse and dependence more clear. The CIWA has also been shortened (now called the CIWA-Ar), while retaining its validity and reliability, to help assess patients more efficiently due to the life-threatening nature of alcohol withdrawal.[30]
Other conditions that may present similarly include benzodiazepine withdrawal syndrome (a condition also mainly caused by GABAA receptor adaptation).