40% will develop acute alcohol withdrawl on stopping or significant reduction

Mechanism

• chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
• alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)

Assessment of alcohol withdrawal

The first step is to assess the patient to identify:

• Associated health and psycho-social problems.
• The severity of the alcohol misuse using e.g. AUDIT questionnaire and SADQ questionnaire.
• Clinical institute Withdrawl assessment - to assess alcohol withdrawl severity
• Whether there is any risk to self or others.

Features

• symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety, nausea, vomitting

3 signs of severe withdrawl: fever, tachycardia, poor physical health

• peak incidence of seizures at 36 hours
• peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Indications for admissions for alcohol dependence