Alcohol withdrawal effects MOHW August 2020

Adapted from NICE guidelines/NZ.org.nz

Minor:
Most manifest a minor syndrome complex
Assess
give appropriate treatment
can be discharged home
Severe alcohol withdrawal
Patient with fits
Has established DT
Admit patient after full neurological examination
Benzodiazepine most commonly used to control symptoms
Higher doses daily for one to three days then reduce dose for next 4 to 7 days
Convulsions: treat with IV diazepam. Dose: 0.15-0.25mg/kg (usually 10 to 20 mg) every four hours by
slow IV infusion.
Further management will be continued by psychiatrist
Correct dehydration and Electrolyte imbalance
Note: individuals with chronic alcohol abuse may suffer from head trauma and therefore need regular
neurological assessment.

● Traumatic brain injury

● Subdural hematoma

● Extradural hematoma,

Resulting in fits.
Alcohol related problems

● Alcohol intoxication

● Alcohol withdrawal

● Aggressive behaviour

You can work out how many units there are in any drink by multiplying the total volume of a drink (in
ml) by its ABV-Alcohol by volume (measured as a percentage) and dividing the result by 1,000.
● strength (ABV) x volume (ml) ÷ 1,000 = units

For example, to work out the number of units in a pint (568ml) of strong lager (ABV 5.2%):
 ● 5.2 (%) x 568 (ml) ÷ 1,000 = 2.95 units

150-200mg/100ml =symptoms of moderate intoxication

Higher levels (up to 350mg) – stupor /coma.
Above 450mg/dl: potentially fatal

Note to doctor:
Mild intoxication can be given treatment (usually oral sedatives) and be managed at home under
surveillance by relatives.
Severe intoxication
Admit patient
Ensure close monitoring
Monitor level of consciousness (hourly)
Monitor cardiac activity
Monitor urine output
Check blood glucose and electrolytes
Correct hypoglycemia and Electrolyte imbalance
IV fluids to correct dehydration
IV Thiamine 250-500mg daily for 3-5 days/or equivalent.
Further treatment with psychiatrist and team.
In cases of circulatory collapse add inotropic agents
Check for aspiration pneumonia and treat
Some patients may require ventilatory support
Note: Some patients may have cerebral edema, CVA, meningitis or high blood pressure.
High Blood pressure may be seen secondary to acute withdrawal.
Give adequate sedation first then consider treating elevated blood pressure.