Alcohol Withdrawal in a Hospital Setting

About this course

Alcohol use disorder is characterized by an unrelenting pattern of drinking that leads to distress or impairment, with symptoms ranging from mild to severe. Alcohol withdrawal is a cluster of symptoms experienced by an individual with sustained alcohol use once alcohol consumption suddenly decreases or is stopped. This course examines alcohol use disorder and withdrawal, discussing their physiological effects, risk factors, signs of withdrawal, and how withdrawal is diagnosed and treated, in addition to providing important nursing considerations when caring for the alcohol dependent patient.

Learning objectives

• Describe alcohol use disorder and alcohol dependency behaviors.
• Describe the central nervous system effects of ethanol, and the physiological effects of alcohol withdrawal.
• Identify symptoms of alcohol withdrawal.
• Review factors associated with an increased risk of alcohol withdrawal in an alcohol dependent person.
• Understand common modalities of treatment for symptoms of alcohol withdrawal.

Course outline

19 sections · finish in any order across devices

1. 1

   Introduction

   Alcohol withdrawal is a cluster of symptoms experienced by an individual with sustained alcohol use once alcohol consumption suddenly decreases or is stopped.1 Also known as alcohol withdrawal syndrome, it is a common problem in hospitals and emergency rooms, with reports estimating that 55% of hosp

   4 min

2. 2

   Define Alcohol Use Disorder

   Alcohol use disorder (AUD) refers to a pattern of harmful drinking and excessive behaviors that lead to negative consequences in various areas of an individual's life, including health, social relationships, work or school performance, and overall well-being.5

   4 min

3. 3

   Alcohol Dependency Behaviors

   Individuals with alcohol dependency, also known as alcohol use disorder (AUD), exhibit a range of behaviors that reflect their compulsive and problematic relationship with alcohol. Alcohol use disorder is characterized by an unrelenting pattern of drinking that leads to distress or impairment, with

   4 min

4. 4

   Define Alcohol Withdrawal

   Alcohol withdrawal is often seen in those who consume large quantities of alcohol, consume alcohol frequently, or are chronic alcohol users, as their central nervous system (CNS) has become accustomed to the presence of alcohol.1,6

   4 min

5. 5

   Risks of Alcohol Withdrawal

   If a patient with alcohol withdrawal is left unmanaged or is not treated promptly, symptoms can progress and become serious complications. It is estimated that up to 5% of patients experiencing alcohol withdrawal experience serious complications such as delirium tremens (DT), seizures, and cardiovas

   4 min

6. 6

   Diagnosing Alcohol Withdrawal

   Typically, alcohol withdrawal is diagnosed based on two criteria:6

   4 min

7. 7

   Clinical Institute Withdrawal Assessment for Alcohol (CIWA) Scale

   The Clinical Institute Withdrawal Assessment for Alcohol (CIWA or CIWA-AR for the revised version), is a 10-item scale that assigns points 0 – 7 to each item independently. These points are aggregated to yield a score that relates to the severity of alcohol withdrawal.9

   4 min

8. 8

   Diagnosing Moderate to Severe Alcohol Withdrawal

   Along with common symptoms seen in mild cases of alcohol withdrawal, moderate to severe cases will also include hallucinations that may last up to 6 days and generalized tonic-clonic seizures that begin within 6 – 48 hours after cessation of alcohol consumption.8

   4 min

9. 9

   History of Withdrawal

   A prior history of alcohol withdrawal increases the risk of more severe symptoms upon subsequent cessation of alcohol intake. This phenomenon, also known as kindling, is believed to be related to the sensitization of the brain's withdrawal pathways due to repeated episodes of withdrawal and alcohol

   4 min

10. 10

    Co-Existing Medical Conditions

    Patients with certain co-morbidities, such as liver disease, cardiovascular disease, diabetes, epilepsy, and psychiatric disorders, are at an elevated risk for more severe and complicated withdrawal symptoms. These medical conditions can interact with the physiological effects of alcohol withdrawal,

    4 min

11. 11

    Treatment Options

    Treatment for alcohol withdrawal is detoxification that is focused on three objectives: (1) to provide a safe withdrawal, (2) to provide humane withdrawal, and (3) to prepare the patient for continuing treatment.11 For this reason, supportive care-only protocols are typically not used, and medicatio

    4 min

12. 12

    Benzodiazepines

    The standard medication used to treat alcohol withdrawal is benzodiazepines. This class of drugs mimics the effects of alcohol on the central nervous system by stimulating the GABA receptors in the brain, decreasing neuronal activity, and causing sedation. By gradually reducing the dosage of the ben

    4 min

13. 13

    Fixed-dose protocol

    Fixed-dose protocol administers a standard dose of benzodiazepine following a fixed schedule, regardless of the severity of withdrawal symptoms. The initial dose is determined by the presenting symptoms and the time duration since the last alcohol consumption. Typically, starting doses begin at 20 m

    4 min

14. 14

    Seizures and Delirium Tremens

    Seizure and delirium tremens are critical conditions that require immediate treatment and close monitoring. Management focuses on achieving a calm, awake state using benzodiazepines. A further high dose of benzodiazepines, such as 20 – 60 mg of diazepam, may be necessary for more seizures and DT dev

    4 min

15. 15

    Anticonvulsants

    Recent findings suggest anticonvulsants such as carbamazepine, gabapentin, and vigabatrin may be suitable alternatives for treating alcohol withdrawal in patients with mild to moderate symptoms. Research has shown they may reduce the risk of withdrawal, seizure, and cravings without the same sedativ

    4 min

16. 16

    Multivitamins and Electrolyte Replacement

    Multivitamins and electrolyte replacement have now become part of standard treatments. Alcohol-dependent patients, especially those with poor diet and signs of malnutrition, are typically deficient in vitamins and electrolytes, such as thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin

    4 min

17. 17

    Adjunctive Treatments

    Depending on the severity and symptoms of the alcohol, additional treatments may be recommended.

    4 min

18. 18

    Nursing Considerations

    Even in mild cases of alcohol withdrawal, the detoxification process is uncomfortable. Patients will need supportive care throughout detoxification, in addition to medication to treat symptoms.1,6,7,13 Therefore, it is essential to provide comfort and relaxation for patients. They should preferably

    4 min

19. 19

    Conclusion

    Alcohol withdrawal is a complex and potentially serious medical condition that requires careful assessment, intervention, and management, especially in a hospital setting. The prevalence of alcohol withdrawal syndrome among hospitalized patients underscores the importance of healthcare professionals

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Hawkins, E. (2018). Alcohol withdrawal symptoms: A quick aid to safe and smooth recovery from alcohol and alcoholism withdrawal symptoms. Independently Published.
• Schuckit, M. A. (2014). Recognition and Management of Withdrawal Delirium (Delirium Tremens). New England Journal of Medicine, 371(22), 2109–2113. https://doi.org/10.1056/nejmra1407298
• Alcohol Use Disorder (AUD) in the United States: Age Groups and Demographic Characteristics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2023). Www.niaaa.nih.gov. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics
• Alcohol-Related Emergencies and Deaths in the United States | National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2023). Www.niaaa.nih.gov. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states
• American Psychiatric Association. (2018). The American psychiatric association practice guideline for the pharmacological treatment of patients with alcohol use disorder. American Psychiatric Pub.
• Czarnik, S., Kocan, M. J., Strobbe, S., Alaniz, C., Ciarkowski, S., Kirst, N., Lukela, M., Malloy, K., Seyfried, L., Somand, D., Walker, P., Wood, W., & Seagull, F. J. (2020). Alcohol Withdrawal in Hospitalized Patients: Michigan Alcohol Withdrawal Severity (MAWS) Protocol. In PubMed. Michigan Medicine University of Michigan. https://www.ncbi.nlm.nih.gov/books/NBK555603/
• Grover, S., & Ghosh, A. (2018). Delirium Tremens: Assessment and Management. Journal of Clinical and Experimental Hepatology, 8(4), 460–470. https://doi.org/10.1016/j.jceh.2018.04.012
• Bharadwaj, B., & Kattimani, S. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial Psychiatry Journal, 22(2), 100. https://doi.org/10.4103/0972-6748.132914
• Sharp, A. (2022, March 10). CIWA-AR Assessment for Alcohol Withdrawal. American Addiction Centers. https://americanaddictioncenters.org/alcoholism-treatment/ciwa-ar-alcohol-assessment
• Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2016). Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4–16. https://doi.org/10.1111/ane.12671
• ASAM Home Page. (2019). Asam.org. https://www.asam.org/
• Jaeger, T. M., Lohr, R. H., & Pankratz, V. S. (2001). Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome in Medical Inpatients. Mayo Clinic Proceedings, 76(7), 695–701. https://doi.org/10.4065/76.7.695
• Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal Of Clinical and Diagnostic Research, 9(9). https://doi.org/10.7860/jcdr/2015/13407.6538
• Dundee, J. W., McGowan, W. A., Lilburn, J. K., McKay, A. C., & Hegarty, J. E. (1979). Comparison of the actions of diazepam and lorazepam. British Journal of Anaesthesia, 51(5), 439–446. https://doi.org/10.1093/bja/51.5.439
• Mueller, S. W., Preslaski, C. R., Kiser, T. H., Fish, D. N., Lavelle, J. C., Malkoski, S. P., & MacLaren, R. (2014). A Randomized, Double-Blind, Placebo-Controlled Dose Range Study of Dexmedetomidine as Adjunctive Therapy for Alcohol Withdrawal*. Critical Care Medicine, 42(5), 1131–1139. https://doi.org/10.1097/ccm.0000000000000141
• Forteza, F. J. (2020). Wernicke encephalopathy in elderly related to severe malnutrition. Theisler, C. (2022). Wernicke-Korsakoff syndrome. Adjuvant Medical Care, 359-360. https://doi.org/10.1201/b22898-352

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