Alcohol Withdrawal: Clinical Findings and Complications The onset of alcohol withdrawal generally begins 6-24 hours after the last drink with symptoms peaking between 24-36 hours after and gradually lessening. Symptoms typically progress from early symptoms and increased sympathetic activity -> hallucinations -> seizures -> potentially Delirium Tremens. Alcohol withdrawal is mild-moderate in severity for 90% of patients. Those who progressively worsen however can enter Delirium Tremens (DT) which has a mortality rate of up to 20%. More likely to have DT if had DT before, age >30 years, concurrent illness, >2 days after EtOH cessation before seeking help, and history of sustained drinking. • Increased Sympathetic Activity - Tachycardia, hypertension, tremor and diaphoresis • Hallucinations - Commonly visual (but can be auditory or tactile), develop 12-24 hours after alcohol cessation. • Early Symptoms - Anxiety, insomnia, vivid dreams, anorexia, nausea, headache and psychomotor agitation • Generalized Tonic-Clonic Seizures - Usually begin within 8-24 hours of alcohol cessation and peak after 24 hours. Risk of having seizures with repeated withdrawals. 1/3 of people can progress to DT if seizures left untreated. • Delirium Tremens (DT) - Life-threatening state of greatly exaggerated withdrawal symptoms (severe tachycardia, diaphoresis etc.) with confusion/disorientation and hallucinations that generally appears 72-96 hours after the last drink and lasts 2-3 days. #Alcohol #Withdrawal #Pathophysiology #Diagnosis #Signs #Symptoms #EtOH
