Withdrawal state in alcohol addiction and its treatment

Alcohol withdrawal state or withdrawal syndrome, occurs mainly in people with long-term and intensive abuse of alcohol. It can range from uncomplicated withdrawal symptoms to a life-threatening condition – delirium tremens. It develops within "6-48 hours" after stopping or substantially reducing alcohol intake.

Symptoms of uncomplicated alcohol withdrawal

• Tremor (most often hands), increased sweating, tachycardia, increased blood pressure, anxiety, inner restlessness, irritability, malaise or weakness, paresthesia of limbs, nausea, vomiting, sleep disorders, terrifying dreams, fleeting hallucinations.
• Wears off within 3–5 days.

Alcohol withdrawal therapy

• mode measures – rest mode, removal of redundant stimuli, quiet semi-dark room, blood pressure and pulse monitoring,
• benzodiazepines, tiapride, clomethiazole in capsules for severe courses (only during hospitalization), thiamin, magnesium,
• sufficient hydratation and ensuring electrolyte balance.

Complications of alcohol withdrawal

• Epileptic seizures – the drug of choice is benzodiazepines, especially diazepame; then MgSO₄ 10% or 20% in intravenous or intramuscular administration.
• Progression to delirium.

Delirium tremens

This is the most severe form of withdrawal syndrome. It develops in 5–6 % of alcohol addicts, typically in the 2.–3. day of abstinence. Sometimes it starts already when intoxication is fading, rarely even during a drinking binge (intoxication delirium). Mortality was previously reported to be 5–10 %, according to more recent studies it does not exceed 1 %.

Set of symptoms of a delirious state

1. Mental: great psychomotor restlessness with agitation, disorders of consciousness with confusion, temporal and spatial disorientation, visual or tactile hallucinations, sleep disorders (often inversion), incoherent thinking, emotional detachment, fear, anxiety.
2. Somatic and vegetative: tachycardia, increased blood pressure, fever, rapid breathing, disorders of the internal environment (dehydration, electrolyte imbalance), dilated pupils, conjunctival congestion, incontinence.
3. Neurological: tremors (fingers, sometimes even entire limb, head), ataxia, hyperkinesia, hyperreflexia, epileptic paroxysms.

Therapy of the delirious state

Soothing of acute restlessness: clomethiazole (Heminevrin), in doses up to 4,8 g/day, is contraindicated in bronchopulmonary involvement, in which case antipsychotics are recommended (risperidone, tiapride), then benzodiazepines.

Adjustment and maintenance of homeostasis of the internal environment: replenish fluids and minerals, administer MgSO₄, group B vitamins, glucose.

Prevention and treatment of somatic complications: most often liver function disorders, pneumonia, GIT bleeding, etc.

Links

Related articles

• Mental disorders caused by alcohol consumption
• Alcohol addiction treatment

Literature used

• RABOCH, Jiří, – PAVLOVSKÝ, Pavel,. Psychiatrie. 1.. edition. Karolinum Press, 2013. 468 pp. ISBN 9788024619859.

Source

• BENEŠ, Jiří. Studijní materiály [online]. [cit. 2010]. <http://jirben.wz.cz>.