Alcohol Withdrawal, Part 1

Summary Drinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting. Morbidity and Mortality Almost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment. Story Ever drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal. Key Points 1. Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal. 2. Severe symptoms may include hallucinations, delirium, seizures, and death 3. Vitamin and electrolyte repletion are critical for sick alcohol dependent patients. 4. Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting! References -Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994 - Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015 - https://www.who.int/news-room/fact-sheets/detail/alcohol - Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. - In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/ - Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019 - Wikipedia, alcohol withdrawal syndrome - Personal experience treating ETOH withdrawal in the inpatient and outpatient setting