When treating a patient with alcohol abuse, it’s wise to evaluate and treat the patient for complications of both alcohol abuse and alcohol withdrawal.
Complications of Alcohol Withdrawal
- Minor withdrawal symptoms (6-48 hours after last drink. start about 6 hrs after last drink and resolve within 24 to 48 hours if withdrawal doesn’t progress). Due to CNS hyperactivity. Symptoms include tremulousness, mild anxiety, insomnia, GI upset (anorexia), headache, diaphoresis, and palpitations.
- Withdrawal seizures. Are usually generalized tonic-clonic seizures. Typically occurs within 48 hours after the last alcoholic drink. If untreated, 1/3 will progress to delirium tremens.
- Todd’s Paralysis after withdrawal seizures. This is post-ictal paralysis that occurs after a seizure and often resolves completely within 48 hours.
- Alcoholic hallucinosis. 12-48 hours after last drink. Typically visual hallucinations.
- Delirium Tremens (DT). Typically starts between 48 and 96 hours after the last drink and lasts 1 to 5 days. As the name implies, DT symptoms include disorientation, agitation, hallucinations, tachycardia, hypertension, fever (hyperthermia), and diaphoresis.
Complications of Alcohol Abuse
- Alcoholic hepatitis
- Alcoholic Cirrhosis
- Hepatic Encephalopathy
- Hepatorenal syndrome
- Spontaneous Bacterial Peritonitis (SBP)
- Alcoholic Pancreatitis
- Malnutrition
Further Reading
Am Fam Physician. 2013 Nov 1;88(9):589-595. Outpatient Management of Alcohol Withdrawal Syndrome.