Symptoms of Alcohol Withdrawal Syndrome continued...
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
- 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.
Treatment of Alcohol Withdrawal Syndrome
If you have mild to moderate withdrawal symptoms, your doctor may prefer to treat you in an outpatient setting, especially if you have supportive family and friends. Outpatient detoxification is safe, effective, and less costly than inpatient detoxification at a hospital or other facility.
However, you may require inpatient treatment if you don't have a reliable social network, are pregnant, or have a history of any of the following:
- Severe withdrawal symptoms
- Withdrawal seizures or DTs
- Multiple previous detoxifications
- Certain medical or psychiatric illnesses
The goals of treatment are threefold: reducing immediate withdrawal symptoms, preventing complications, and beginning long-term therapy to promote alcohol abstinence.
Prescription drugs of choice include benzodiazepines, such as diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax). Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine (Tegretol) may be an effective alternative to benzodiazepines, because it is not sedating and has low potential for abuse.
To help manage withdrawal complications, your doctor may consider adding other drugs to a benzodiazepine regimen. These may include:
- An antipsychotic drug, which can help relieve agitation and hallucinations
- A beta-blocker, which may help curb a fast heart rate and elevated blood pressure related to withdrawal and reduce the strain of alcohol withdrawal in people with coronary artery disease
Clonidine (Catapres), another blood pressure drug
- Phenytoin (Dilantin), an anticonvulsant which doesn't treat withdrawal seizures but may be useful in people with an underlying seizure disorder