Management of moderate and severe alcohol withdrawal syndromes - UpToDate

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• alcohol-naïve volunteers given continual alcohol for longer periods developed more severe withdrawal than those who drank for shorter periods

• Symptoms are usually present within six hours of the cessation of drinking and often develop while patients still have a significant blood alcohol concentration

• If withdrawal does not progress, these findings resolve within 24 to 48 hours.

• Withdrawal-associated seizures are generalized tonic-clonic convulsions that usually occur within 12 to 48 hours after the last alcoholic drink

• typical onset during the fourth and fifth decades of life.

• Benzodiazepines, phenobarbital, and propofol are recommended in that order to treat status epilepticus

• phenytoin is ineffective in the treatment of alcohol withdrawal seizures

• alcohol withdrawal seizures left untreated progress to delirium tremens (DT) in nearly one-third of patients

• Alcoholic hallucinosis refers to hallucinations that develop within 12 to 24 hours of abstinence and typically resolve within 24 to 48 hours

• Patients are aware that they are hallucinating

• often very distressed

• is not associated with global clouding of the sensorium, but only with specific hallucinations, and vital signs are usually normal.

• 5 percent of patients who undergo withdrawal from alcohol suffer from DT

• hallucinations, disorientation, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis

• begins between 48 and 96 hours after the last drink and lasts one to five days

• Virtually all patients who develop DT experience some symptoms of minor alcohol withdrawal prior to the onset of DT

• elevated cardiac indices, oxygen delivery, and oxygen consumption

• Arterial pH rises due to hyperventilation

• Hyperventilation and consequent respiratory alkalosis in this setting result in a significant decrease in cerebral blood flow

• correlation between the length of the preceding alcohol binge, the degree of clouding of the sensorium, and the size of the average decrease in cerebral hemispheric blood flow