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Withdrawal, Alcohol, Emergency Medicine

Trevonne M. Thompson Reviewed 06/2017



  • Alcohol withdrawal is the most common withdrawal syndrome encountered in the emergency department

  • Neuroexcitation is the hallmark of alcohol withdrawal

  • Alcohol withdrawal may be life t...


Signs and Symptoms

  • Early withdrawal:

    • Occurs: 6–8 hr after the last drink

    • Duration: 1–2 days

      • Tremulousness

      • Anxiety

      • Palpitations

      • Nausea

      • Anorexia

  • Withdrawal seizures:

    • Occurs: 6–48 hr after the last drink

    • ...



  • Assess vital signs

  • Assess capillary glucose

Initial Stabilization/Therapy

  • Attention to the ABCs

  • Obtain IV access

  • IV fluid administration

  • Cardiopulmonary monitoring

Ed Treatment/Procedures



Admission Criteria

  • Moderate-to-severe symptoms

  • Persistent symptoms despite treatment

  • DTs or impending DTs

  • Comorbid medical illness

Discharge Criteria

Mild symptoms and signs responsive ...

Pearls and Pitfalls

  • Misdiagnosis of medical disease as withdrawal syndrome

  • Misunderstanding the relationship between withdrawal syndromes and comorbid medical illness

  • Administer sufficient quantities of...

Additional Reading

  • Carlson  RW, Kumar  NN, Wong-Mckinstry  E, et al. Alcohol withdrawal syndrome. Crit Care Clin.  2012;28(4):549–585.

  • DeBellis  R, Smith  BS, Choi  S, et al. Management of deliriu...



  • 291.0 Alcohol withdrawal delirium

  • 291.3 Alcohol-induced psychotic disorder with hallucinations

  • 291.81 Alcohol withdrawal

  • 291.1 Alcohol-induced persisting amnestic disorder

  • 291.5 Alcohol-induced ...

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