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Substance Abuse and Addiction Health Center

Alcohol Withdrawal

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Symptoms of Alcohol Withdrawal Syndrome

In general, the severity of alcohol withdrawal symptoms increases in tandem with the amount and duration of prior alcohol consumption.

Minor alcohol withdrawal symptoms often appear six to 12 hours after alcohol cessation, sometimes while patients still have a measurable blood alcohol level. These symptoms include:

  • Shaky hands
  • Sweating
  • Mild anxiety
  • Nausea and/or vomiting
  • Headache
  • Insomnia

Between 12 and 24 hours after alcohol cessation, some patients may experience visual, auditory, or tactile hallucinations which usually end within 48 hours. Although this condition is called alcoholic hallucinosis, it's not the same as the hallucinations associated with DTs. Most patients are aware that the unusual sensations aren't real.

Withdrawal seizures usually first strike between 24 and 48 hours after alcohol cessation. The risk of seizures is especially high in patients who previously have undergone multiple detoxifications.

DTs usually develop between 48 and 72 hours after alcohol cessation, although they can appear as early as two hours after cessation. Risk factors for DTs include a history of withdrawal seizures or DTs, acute medical illness, abnormal liver function, and older age.

Symptoms of DTs, which usually peak at five days, include:

  • Disorientation, confusion, and severe anxiety
  • Hallucinations (primarily visual) which cannot be distinguished from reality
  • Profuse sweating
  • Seizures
  • High blood pressure
  • Racing and irregular heartbeat
  • Severe tremors
  • Low-grade fever

 

Assessment of Alcohol Withdrawal Syndrome

If alcohol withdrawal syndrome is suspected, your doctor will take a complete medical history and ask how much you drink, how long you've been drinking, and how much time has elapsed since your last drink. He or she also will want to know if you have a history of alcohol withdrawal, if you abuse any other substances, and if you have any medical or psychiatric conditions.

During a physical exam, your doctor will identify alcohol withdrawal symptoms and any potential complicating medical conditions such as irregular heartbeats, congestive heart failure, coronary artery disease, gastrointestinal bleeding, infections, liver disease, nervous system impairment, and pancreatitis. He or she also may order blood tests to measure complete blood count, alcohol and electrolyte levels, liver function, and a urine screen to identify drug use.

The results of the medical history and physical exam will help your doctor decide if you have alcohol withdrawal syndrome and, if so, its severity. 

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