Alcohol Withdrawal Syndrome

Alcohol withdrawal syndrome occurs when patients who have ethanol induced cellular tolerance to alcohol stop drinking. The symptoms are caused by sudden withdrawal of the CNS depressant effects of alcohol. Symptoms can range from a mild hangover effect to life threatening seizures.

Features of withdrawal include a tremor of the hands (shakes or jitters), autonomic nervous system dysfunction (i.e. increases in pulse, respiratory rate, temperature and blood pressure, insomnia and bad dreams, anxiety or panic attacks) and GI upset. These symptoms begin within 0 to 5 hours of decreasing ethanol intake and peak in intensity on day 2 or 3. Symptoms usually begin to improve by the fourth or fifth day of withdrawal.

Only 5% of patients in withdrawal show severe symptoms, such as delirium tremens (a state of confusion accompanied by hallucinations) or generalized seizures.

Prevention of alcohol withdrawal is important in the patient undergoing surgery and in the postoperative period. The primary goals of medical prevention are to minimize the severity of symptoms and to prevent severe withdrawal symptoms, such as seizures. Benzodiazepines have been shown to decrease the incidence of seizures and delirium tremens. Chlordiazepozide, diazepam, lorazepam and oxazepam are the agents most commonly used for this purpose. Beta blockers are added to prevent autonomic dysfunction. Alpha agonists have also been shown to decrease withdrawal symptoms. In addition, the antiepileptic, carbamazepine, has been shown to decrease the severity of withdrawal and to prevent seizures.

A medicine consult for the alcoholic patient undergoing surgery can help prevent problems related to alcohol withdrawal and to facilitate the patient’s post hospital care, which should include enrollment in an alcohol treatment program.