alcoholwithdrawalsyndrome(aws)-MaricopaMedicalCenter.docVIP

ALCOHOL WITHDRAWAL SYNDROME (AWS) SUMMARY: Alcohol withdrawal syndrome (AWS) is a common entity in the ICU patient. It is imperative to identify those at risk and observe them carefully for the development of symptoms. Alcohol withdrawal delirium is the most serious manifestation of AWS and the initial goal is control of agitation. Much controversy exists regarding who needs to be treated and with what drug but benzodiazepines remain the agents of choice in preventing alcohol withdrawal seizure activity. Adjunctive forms of treatment include beta-blockers, clonidine, and haldol. INTRODUCTION: Alcohol abuse is a common comorbidity in the surgical, trauma, and critically ill patient population. Alcohol withdrawal syndrome is a well described entity that leads to increased patient morbidity and mortality. Alcohol withdrawal delirium is the most serious manifestation of AWS and is commonly known as delirium tremens (DTs). This occurs in approximately 5% of patients with AWS. Current diagnostic criteria of DTs includes disturbances of consciousness, change in cognition or perceptual disturbance developing in a short period, and the emergence of symptoms during or after withdrawal from heavy alcohol intake. The classic presentation includes hyperpyrexia, tachycardia, hypertension and diaphoresis. Clinical features of AWS can occur within hours of not drinking but DTs typically does not develop until after 3-5 days but as far out as . Withdrawal seizures occur in approximately 5-15% of those with AWD. Estimated mortality if DTs occur is in the range of 5-15% and is usually secondary to cardiac arrhythmia or respiratory failure. Treatment begins with recognition of those at risk. These patients must be closely monitored for signs and symptoms consistent with AWS. Various scales and questionnaires exist to evaluate patients for possible alcohol misuse. It is imperative to identify those patients that have had prior episodes of AWS or DTs because of the