Alcohol Withdrawal Syndrome

The consultants at Godoy Medical Forensics often help their attorney clients with cases that involve alcohol abuse and addiction. Individuals who discontinue alcohol after prolonged use experience physiological and behavioral symptoms. Alcohol withdrawal syndrome is a serious and potentially life threatening condition that requires medical treatment. 

Alcohol is a drug that has a depressant or slowing effect on the brain. When alcohol is withdrawn after habitual use, the opposite occurs and brain becomes excitable. The symptoms of alcohol withdrawal reflect this excitability, for example tremors, irritability, and seizures. Symptoms of alcohol withdrawal can occur from 6-72 hours after the last drink. Withdrawal symptoms are categorized by most references as minor symptoms which occur 6-12 hours after the alcoholic’s last drink and major symptoms which occur 24-72 hours after the last drink. 

2/14 Minor Symptoms

Kneisel (2009) identifies minor symptoms as anxiety, agitation and irritability. These symptoms progress to include tremor, elevated blood pressure and elevated heart rate, low grade fever, headache and sweating. Gastrointestinal symptoms such as loss of appetite, nausea, vomiting and diarrhea may be present. There may be sleep disturbance and nightmares. The symptoms of minor withdrawal may be experienced for 48-72 hours and can be prevented from progressing to major withdrawal with treatment. 

2/21 Major withdrawal 

Major withdrawal symptoms usually appear 2-3 days after the last drink and can include delirium tremens (DT’s). Symptoms of DT’s include elevation in heart rate, blood pressure and temperature noted above with the addition of confusion, disorientation, agitation, visual and auditory hallucinations and seizures. These symptoms usually last for 3-5 days but can be of longer duration (Kneisl, 2009). Major alcohol withdrawal can be fatal.

2/28 Treatment 

Early detection of alcohol withdrawal is the most important aspect of treatment (Kneisl, 2009). It can be easily misdiagnosed in the elderly. Disorientation can be normalized as a sign of aging rather than withdrawal. Patients who are hospitalized for medical illness can hide their drinking history for a variety of reasons. Their symptoms of withdrawal can be misdiagnosed as neurological illness or a side effect of medication. Clients who come in contact with the legal system can experience behavioral changes such as agitation, confusion and hallucinations that are directly related to their withdrawal from alcohol. Their behavior can be misunderstood or thought to be related to substance intoxication.

Medical treatment of alcohol withdrawal symptoms involves replacing fluids, vitamin supplements (especially thiamine and folic acid) and treatment with benzodiazepine medication (such as Librium or clonazepam) and nutritional support. Medication to treat high blood pressure, heart rate and anti-seizure medication may be prescribed (Ignatavicius & Workman, 2010). 

Summary

Alcohol withdrawal symptoms can cause physiological and behavioral changes in alcoholic dependent individuals who discontinue use. Minor symptoms can occur 12-24 hours after the last drink. Major symptoms can occur 2-3 days after the last drink and include delirium tremens. These symptoms include seizures and hallucinations and can be life threatening. Treatment involves early detection, medication, and fluid replacement and vitamin supplements.

  

Works Cited

Ignatavicius, D., & Workman, L. (2010). Medical-Surgical Nursing. St. Louis: Saunders.

Kneisl, C. a. (2009). Contempory Psychiatric-Mental Health Nursing. Upper Saddle River: Pearson Prentice Hall.

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