Alcohol Withdrawal – Sign & Symptoms, Treatments


A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use. Someone who is alcohol-dependent may persist in drinking, despite harmful consequences. They will also give alcohol a higher priority than other activities and obligations.

For people who are alcohol dependent but not admitted to hospital, offer advice to avoid a sudden reduction in alcohol intake1and information about how to contact local alcohol support services. People with decompensated liver disease who are being treated for acute alcohol withdrawal should be offered advice from a healthcare professional experienced in the management of patients with liver disease


The signs and symptoms of AW typically appear between 6 and 48 hours after heavy alcohol consumption decreases.

Initial symptoms may include headache, tremor, sweating, agitation, anxiety and irritability, nausea and vomiting, heightened sensitivity to light and sound, disorientation, difficulty concentrating, and, in more serious cases, transient hallucinations. These initial symptoms of AW intensify and then diminish over 24 to 48 hours. Delirium tremens (DT’s), the most intense and serious syndrome associated with

Other alcohol withdrawal symptoms is classified as characterized by

  • Anxiety, insomnia, nausea, and abdominal pain characterize this stage, which begins 8 hours after the last drink.
  • High blood pressure, increased body temperature, unusual heart rate, and confusion come with this stage, which begins 24-72 hours after the last drink.
  • Hallucinations, fever, seizures, and agitation come with this stage, which tends to begin 72+ hours after the last drink.


  • A thorough assessment also should anticipate health problems that frequently occur in patients withdrawing from alcohol.
  • These complications may include the following:
  • Gastritis (i.e., an inflammation of the stomach lining, which often is associated with bleeding)
  • Gastrointestinal bleeding (e.g., from the esophagus, stomach, or intestines)
  • Liver disease
  • Cardiomyopathy (i.e., any disorder of the heart muscle)
  • Pancreatitis (i.e., an inflammation of the pancreas)
  • Disturbances in the electrolyte balance (e.g., alcohol ketoacidosis— a metabolic derangement that results in too much acid in the bloodstream—and abnormally low levels of magnesium in the blood)
  • Deficiency of the vitamin folate, which can cause lower-than-normal numbers of blood cells
  • Deficiency of the vitamin thiamine, which can lead to serious neurological problems


  • Counseling

It is a beneficial treatment for alcoholic patient. Counseling sessions are needed in large amount. In this patient get to know about the conditions of alcoholism and there side affect

  • Pharmacotherapy

Pharmacotherapy to treat the symptoms of acute alcohol withdrawal as follows: Consider offering a benzodiazepine or carbamazepine.

Clomethiazole may be offered as an alternative to a benzodiazepine or carbamazepine. However, it should be used with caution, in inpatient settings only and according to the SPC.

  • Self and mutual help

Having self-control over alcohol intake nor making it in habit. taking alcohol in small amount

  • General Care

Abnormalities in fluid levels, electrolyte levels, or nutrition should be corrected. Intravenous fluids may be necessary in patients with severe withdrawal because of excessive fluid loss through hyperthermia, sweating, and vomiting. Intravenous fluids should not be administered routinely in patients with less severe withdrawal, because these patients may become overhydrated. Routine administration of magnesium sulfate has not been shown to improve withdrawal symptoms

  • Monitoring

For more severe / decompensated liver disease monitor closely and consider symptom triggered approach using lowest possible prn dosages Consider strongly discussing with doctor

Written By:

DEEPTIDeepti Rawat 

Trainee Medical Coder, Delhi