Alcohol Withdrawal Syndrome

November 12, 2012

Alcohol Withdrawal Syndrome

People who are or have been heavy drinkers for a period of time can be struck down by a potentially fatal condition known as Alcohol Withdrawal Syndrome. This can happen to anyone who has been a drinker for a time period as short as weeks or as long as years who is trying to stop drinking or cut back their alcohol intake.

DT’s are known about by many people but what is not common knowledge is that between 1% and 5% of people suffering from delirium tremens (DT’s) actually dies. Common symptoms of DT’s are confusion, rapid heartbeat and fever. Withdrawal from alcohol can induce symptoms that last for weeks. Within a few hours of stopping drinking the patient can suffer symptoms such as shakiness, anxiety through to seizures and DT’s.

The speed of decline, if you suffer from symptoms related to Alcohol Withdrawal Syndrome, means that you can become ill very quickly. In cases like these it is very important that medical treatment is received quickly, even if the symptoms initially do not appear to be too serious. There are alcohol withdrawal treatments available to reduce the risk of having a seizure.

If you have a history of being prone to infection, heart or lung disease or a history of seizures then you must go and see a doctor if ever you experience an Alcohol Withdrawal Syndrome symptom. Having repeat symptoms whilst withdrawing from alcohol also necessitates a visit to the doctor.

It is imperative that any alcohol withdrawal symptoms are treated as an emergency. If all or any of the common symptoms such as seizures, confusion, irregular heartbeat or fever appear then the patient must seek medical help immediately by either calling an ambulance or getting to the emergency room at the nearest hospital.

When can Alcohol Withdrawal Syndrome occur?

Neurotransmitters are chemicals present in everyone’s brain used to transmit messages. The brain’s neurotransmitters are disrupted because of heavy drinking. Excessive heavy drinking every day is the worse sort of drinking. GABA is the name of the neurotransmitter which makes the individual feel calm and relaxed. Alcohol works by suppressing GABA activity. This means that more alcohol is required to give the same feeling of relaxation as before. This is known as ‘tolerance’.

The neurotransmitter which produces feelings of excitement is called glutamate. Alcoholics drink enough to suppress glutamate. To maintain balance the glutamate system functions at a level much higher than is moderate in non drinkers.

When the body is not getting alcohol, as when a heavy drinker stops, then the neurotransmitters GABA and glutamate are no longer dormant. They effectively go wild resulting in a condition known as brain hyperexcitability. This is why anxiety, agitation, tremors, seizures and irritability are associated with alcohol withdrawal. These are all opposite to the effects felt during alcohol consumption.

Alcohol Withdrawal Syndrome – What to look for?

If the person suffering the alcohol withdrawal symptoms was a heavy and prolonged drinker then generally he or she will have more withdrawal symptoms. Lighter drinkers have fewer symptoms.

From stopping drinking it normally takes between 6 and 12 hours for symptoms to appear. The patient can still have alcohol in his blood at this stage. The symptoms are all or some of the following; shaky hands, mild anxiety, headache, sweating, nausea or vomiting and insomnia. After this, normally 12 to 24 hours since the last drink the patient may have sensory hallucinations known as alcoholic hallucinosis. This isn’t related to DT’s. This stage may take the form of auditory, tactile or visual effects but this normally ceases within 48 hours. Most people passing through these stages realise that what they are sensing is not real.

If the patient starts to display any of the visual symptoms of DTs, disorientation, anxiety, hallucinations, confusion, heavy sweating or fever then he can become liable to seizures. The DTs can be further confirmed by identifying high blood pressure, racing and / or irregular heartbeat and tremors. The high risk time for DTs and hence a seizure is between 48 and 72 hours since the last drink. Those with a higher risk of seizures include those with acute medical illness, a history of seizures or DTs, an abnormal liver function and older people.

Alcohol Withdrawal Syndrome – Do I have it?

Before diagnosing alcohol withdrawal syndrome your doctor will carry out a full physical examination in addition to questioning you about your lifestyle, alcohol consumption and any relevant medical history. The patient must be prepared to state when the last drink was, how long he or she had been drinking for, average daily consumption and any other issues that drinking has caused in their life. The doctor will also need to know if they tried to stop drinking before, and what happened and do they have any medical or psychiatric disorders, and are they a substance abuser.

The physical examination will identify any conditions which may be potentially dangerous such as liver disease, irregular heartbeats, pancreatis, internal bleeding, coronary artery disease or any infections the patient may have. Blood tests can check liver function, alcohol and electrolyte levels and be can used as a tool to check for drug use. It is by carrying out these tests and checks that the doctor will diagnose alcohol withdrawal syndrome and the severity of the episode.

How do you treat Alcohol Withdrawal Syndrome?

Medical history, social and family network and severity of the symptoms are all relevant when deciding whether to admit the patient or deal with them as an outpatient. Being an outpatient is cheaper and is known to be safe and effective if the patient is in a supportive environment and if the patient only has mild or moderate symptoms. If their family and friends can all provide support and help then this is a very effective option.

However if the patient does not have a supportive family, is pregnant or has a history of many previous detoxifications, seizures, severe withdrawal symptoms or has certain medical or psychiatric conditions then they must be treated as an inpatient.

Medical treatment addresses shakiness, anxiety and confusion. By use of standard prescription drugs like diazepam, lorazepam, chlordiazepoxide and oxazepam all of the symptoms described can be eliminated or reduced which helps to reduce the risk of seizures. If the symptoms are not too serious then the anti convulsant drug carbamazepine (Tegretol) may be substituted instead of the drugs named before because it has a lower chance of being abused and does not have a sedating effect.

The treatment is the start of the journey to being alcohol free, but the doctors must first control and eradicate the withdrawal symptoms and ensure that no complications occur before providing the longer term therapy.

In addition to the drugs discussed above the doctor may use antipsychotic drugs. These can reduce hallucinations, which in turn help to keep the patient calm. If blood pressure is an issue then beta-blockers or Clonidine (Catapres) may help with the symptoms. It is not uncommon for a fast heart rate and elevated blood pressure to be related to withdrawal. If the patient has a history of seizures not related to alcohol or DTs then Phenytoin (Dilantin) is an anticonvulsant which may be prescribed.

Alcohol Withdrawal Episodes – The Future

If you never want to have another alcohol withdrawal episode then you must be alcohol free. Treating the alcohol withdrawal symptoms does not help you to deal with alcohol dependence or addiction. As part of the treatment for alcohol withdrawal syndrome most doctors would try to ensure a longer term therapy to help remove the need for alcohol. Some medication is available to help stop drinking but groups like Alcoholics Anonymous or Narcotics Anonymous are also very good as part of a long term plan. For some, the answer is to stay at a comprehensive treatment facility offering support and therapy.

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