It is important to think of alcohol withdrawal as a syndrome the features of which include course tremor, flushed face, mydriasis, diaphoresis, nausea, and autonomic hyperactivity with elevated pulse, blood pressure, and temperature. Pulse and blood pressure elevations may not occur in patients taking beta-blockers and, by themselves, are poor predictors of major withdrawal. Alcohol and sedative hypnotic withdrawal is medically dangerous and requires treatment. Untreated, alcohol withdrawal can result in seizures, delirium, and death. Frequency, amount, and type of alcohol should be noted.
Alcoholics tend to minimize actual amount used.
All patients at risk for alcohol withdrawal should be asked about a history of seizures and delirium tremens. All patients suspected of alcohol withdrawal should be closely monitored. It should be scored hourly for 24 hours, then every 4 hours for 72 hours if stable with return to hourly scoring if the pt deteriorates. Alcohol withdrawal is treated with benzodiazepines as well as with supportive measures, including fluids, thiamine, folate, MVI, and monitoring of electrolytes and magnesium. Standard prn benzodiazepine regimens make no sense unless they are based on continued observation of the pt and assessment of symptoms.