Alcohol Withdrawal Syndrome
The Stages of Alcohol Withdrawal Syndrome
Stages 1: Onset 6-8 hours
SX: agitation, anxiety, tachycardia, hypertension, N & V, anorexia, headache,
insomnia, craving for alcohol, diaphoresis, tremor
Stages 2: Onset 24 hours (may be delayed up to 6 days)
SX: hallucinations (auditory or visual, tacile, olfactory or mixed), illusions,
disordered perception, autonomic hyperactivity of stage 1 continues.
Stages 3: Onset 7-48 hours
SX: grand mal seizures; 3-4% of untread
patiens progress to stage 3; more than 50% have multiple seizures; >30%
have Delirium Tremens if untreated.
Stages 4: Onset 3-5 or more days
SX: Delerium tremens DT, (global
confusion, autonomic hyperactivity, hallucinations); 5-6% of patients progress
to stage 4; in 15% of these, DT resolve in <24 hours; iin 80%, DT usually
resolve in <3 days.
Drug regimens for managing Alcohol Withdrawal
For mild to moderate symptoms:
Chlordiazepoxide/Librium 25-100 mg q6h PO, then taper down dose (Half life
Oxazepam/Serax 15-30 mg q6h PO, then taper down dose (Half life 5-10 h)
Diazepam/Valium 5-20 mg q6h PO, then taper down dose (Half life >10 h)
Lorazepam/Ativan 1-2 mg q4-6h PO, then taper down dose (Half life 5-10
For severe symptoms:
Lorazepam/Ativan 1-4 or more mg q2-4h IV or by IV infusion.(Half life
Midazolam/Versed 1-5 or more mg q2-4h IV or by IV infusion (Half life 1-4h)
Thiamine, fluid & electrolytes (esp. Magnesium), psychiatric evaluatio,
management of coexisting medical/surgical conditions, nutrition, referral
to chemical dependency clinic or rehabilitation program when stable.
Seizure Rx: Lorazepam/Ativan or Diazepam/Valium IV; Dilantin & others
Hypertension Rx: Beta-blockers or Clonidine as indicated.
GI bleeding Rx as indicated.
J of Critical Illness May 1998, Vol 13. No.5 - Richard W. Carlson, etc.