Alchohol Withdrawal Syndrome

Alcohol Withdrawal Syndrome

Alcohol Use Disorder (AUD) is prevalent in trauma patients. For this reason, it is important to know the associated risks of alcohol withdrawal syndrome (AWS) in surgical ICU patients. The spectrum of withdrawal symptoms range from mild to severe and life-threatening. The possible lethal sequela of AWS has resulted in the creation of AWS treatment protocols in many hospitals, including ours.

Minor Symptoms:

Anxiety
Headache
Insomnia
Gastrointestinal symptoms
- nausea
- cramping
- pain

Advanced Symptoms:

Visual or auditory hallucinations
Seizures

Severe Symptoms:

Alcohol withdrawal delirium (a.k.a. delirium tremens)

Alcohol Withdrawal Assessment

Patients may develop Alcohol Withdrawal Delirium (AWD) between 3 - 8 days after alcohol cessation. Fever, tachycardia, agitation, diaphoresis, hallucinations, disorientation, and hypertension. Three to five percent of all patients with alcohol withdrawal syndrome will progress to AWD. Although the incidence of patients who will progress is relatively low, the lethal nature of the progression requires early identification and prevention for those at risk of AWD.

The Clinical Institute Withdrawal Assessment for Alcohol "CIWA" is a validated tool that assesses the severity of withdrawal symptoms.

* Click on image to enlarge

Prevention and Treatment of Alcohol Withdrawal

"An ounce of prevention is worth a pound of cure" - Benjamin Franklin 1736

Prevention of alcohol withdrawal must start with a detailed history and physical exam that yields a history of, or physical findings that, suggest a recent history of alcohol use disorder.

The questions pertinent to early evaluation include:

Last alcohol consumption
Number of drinks per week
History of binge consumption
Previous hospitalization for alcohol related issues
- Toxicity
- Pancreatitis
- Liver dysfunction / sequela of cirrhosis
- Frequent ED visits with + ETOH screens

Pancreatitis
Once a patient is determined to be at risk for alcohol disuse disorder, early initiation of CIWA protocols should occur as well as:
- Thiamine supplement (IV or IM) to treat Wernicke's encephalopathy
- Multivitamin replacement
- Electrolyte correction
- Assessment for malnutrition secondary to AUD

Treatment of Alcohol Withdrawal

Historically, the mainstay of therapy for alcohol withdrawal were benzodiazepines and barbituates. These treatment protocols are beginning to be augmented by newer agents, such as, gamma-aminobutyric adrenergic agents, anti-epileptic drugs and alpha-2 adrenergic receptor agonists. For more information on these options, check out "Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes - Beyond Benzodiazepines" by Dr. Maldonado.

The order set for CIWA and Treatment of Alcohol Withdrawal can be found in EPIC: