By Dr. S.P. Pradhan on 27th November, 2023
Taking alcohol for weeks, months, or longer duration result in withdrawal symptoms; both mental and physical problems when it is stopped abruptly. The symptoms can be from mild to serious with complications.
Alcohol withdrawal symptoms usually occur within 8-12 hours after the last drink. It can occur few days later also. Most symptoms are seen in 24 to 48 hours and it may last for weeks.
Drinking infrequently or only once in few occasions results in rare symptoms when you stop. But if somebody is habituated with moderate to heavy drinking for a period of time it is more likely to go through alcohol withdrawal symptoms.
Common symptoms :
- Anxiety
- Irritability
- Confusion
- Headache
- Tremors
- Nausea
- Vomiting
- Fatigue
- Sweating
- Lack of sleep or Insomnia
- Mental clouding
- Thought block
- Tachycardia or increased heart rate
- Increased blood pressure
Delirium tremens is a very severe form of alcohol withdrawal resulting in:
- Global or severe confusion
- Hallucinations or feeling of things that are not there ; visual or auditory
- Disorientation
- It may result in fits or seizures
Management
Alcoholic withdrawal patients should be dealt carefully to prevent further complications. In case of mild to moderate symptoms, patients should receive supportive therapy. Correction of electrolyte imbalance, intravenous rehydration should be done as supportive therapy.
The vital signs like heart rate, BP should be monitored regularly as in these cases they have labile cardiovascular symptoms. Some patients are given proton pump inhibitors to prevent gastric mucosal damage and acidity.
In comorbid condition called Wernicke-Korsakoff syndrome, patients receive supplements of folate, thiamine, dextrose containing fluids. Body needs to be hydrated as there is autonomic disturbances in alcohol withdrawal.
In case of management for severe symptoms, administration of long-acting benzodiazepines are given. The commonly used benzodiazepines are diazepam or lorazepam. Consultation with a toxicologist is also recommended.
Detoxification is the process of weaning a person from a psychoactive substance in a safe and effective manner by gradually tapering the dependence producing substance or by substituting it with a cross-tolerant pharmacological agent.
In case of withdrawal seizures benzodiazepines and other adjunct therapy with phenytoin, barbiturates used. It may even require intubation and sedation with propofol, ketamine.
Oral chlordiazepoxide is also commonly used for the prevention of withdrawal symptoms. Propofol is used to manage refractory cases of delirium tremens.
Complications in Alcohol withdrawal
- Delirium Tremens as we have discussed
- Seizures
- Wernicke-Korsakoff syndrome
- Depression
- Insomnia
- Hallucinations
- Labile BP, Heart rate
Rehabilitation Care
Alcoholics have nutritional deficiencies especially the B-complex and thus should be provided with folic and thiamine supplements. They patients may benefit from magnesium supplements as magnesium deficiency causes muscle weakness, hyperactive reflexes.
Deterrence and Patient Education
Patient education is utmost important to deal with the situation. Patients need to understand about the alcohol withdrawal symptoms so that successful treatment of alcohol withdrawal syndrome can be undertaken.
Rehabilitation programs can include individual counseling, group meetings, and long-term medications to reduce the risk of relapse. Sell of toxic form of alcohol should be checked and penalised with the court of law.
