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Alcohol withdrawal syndrome
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Ethanol
SpecialtyAddiction Medicine, Critical Care Medicine, Psychiatry
SymptomsAnxiety, shakiness, sweating, vomiting, fast heart rate, mild fever
ComplicationsHallucinations, delirium tremens, seizures
Usual onsetSix hours following the last drink
DurationUp to a week
CausesReduction or cessation of alcohol intake after a period of excessive use
Diagnostic methodClinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
TreatmentBenzodiazepines, thiamine
Frequency~50% of people with alcohol use disorder upon reducing use

Alcohol withdrawal syndrome (AWS) is a set of symptoms that can occur following a reduction in alcohol use after a period of excessive use. Symptoms typically include anxiety, shakiness, sweating, vomiting, fast heart rate, and a mild fever. More severe symptoms may include seizures, seeing or hearing things that others do not, and delirium tremens (DTs). Symptoms typically begin around six hours following the last drink, are worst at 24 to 72 hours, and improve by seven days.

Alcohol withdrawal may occur in those who are alcohol dependent. This may occur following a planned or unplanned decrease in alcohol intake. The underlying mechanism involves a decreased responsiveness of GABA receptors in the brain. The withdrawal process is typically followed using the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar).

The typical treatment of alcohol withdrawal is with benzodiazepines such as chlordiazepoxide or diazepam. Often the amounts given are based on a person's symptoms. Thiamine is recommended routinely. Electrolyte problems and low blood sugar should also be treated. Early treatment improves outcomes.

In the Western world about 15% of people have problems with alcohol use disorder at some point in time. About half of people with alcohol use disorder will develop withdrawal symptoms upon reducing their use, with four percent developing severe symptoms. Among those with severe symptoms up to 15% die. Symptoms of alcohol withdrawal have been described at least as early as 400 BC by Hippocrates. It is not believed to have become a widespread problem until the 1700s.

Signs and symptoms