Alcohol withdrawal seizures: Difference between revisions
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*Onset after last drink: 6-48h | *Onset after last drink: 6-48h | ||
*Multiple seizures: 60% of patients | *Multiple seizures: 60% of patients | ||
*Progression to [[Delerium tremens]] | *Progression to [[Delerium tremens]]: 33% of patients | ||
*May occur in spectrum or independent of [[Alcohol withdrawal]] syndrome | *May occur in spectrum or independent of [[Alcohol withdrawal]] syndrome | ||
Revision as of 11:45, 8 July 2016
Background
- Onset after last drink: 6-48h
- Multiple seizures: 60% of patients
- Progression to Delerium tremens: 33% of patients
- May occur in spectrum or independent of Alcohol withdrawal syndrome
Clinical Features
- Single or multiple brief tonic-clonic seizures in the appropriate time setting for alcohol withdrawal[1]
Differential Diagnosis
- Ethanol toxicity
- Alcohol use disorder
- Alcohol withdrawal
- Electrolyte/acid-base disorder
Seizure
- Epileptic seizure
- First-time seizure
- Seizure with known seizure disorder
- Status epilepticus
- Temporal lobe epilepsy
- Non-compliance with anti-epileptic medications
- Hyponatremia
- INH toxicity
- Non-epileptic seizure
- Meningitis
- Encephalitis
- Brain abscess
- Intracranial hemorrhage
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Barbiturate withdrawal
- Baclofen withdrawal
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia, hepatic failure, uremia
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Acute hydrocephalus
- Arteriovenous malformation
- Seizure with VP shunt
- Toxic ingestion (amphetamines, anticholinergics, cocaine, INH, organophosphates, TCA, salicylates, lithium, phenothiazines, bupropion, camphor, clozapine, cyclosporine, fluoroquinolones, imipenem, lead, lidocaine, metronidazole, synthetic cannabinoids, theophylline, Starfruit)
- Psychogenic nonepileptic seizure (pseudoseizure)
- Intracranial mass
- Syncope
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
Diagnosis
- Clinical features
- Elevated CIWA
- Other diagnoses excluded (ICH from head injury, hyponatremia, etc.)
Management
- Treat with benzos (not phenytoin)
- See Alcohol withdrawal: Inpatient management
Disposition
- Admission
See Also
- Alcohol withdrawal
- Delerium tremens
- EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal
External Links
References
- ↑ Manasco A, Chang S, Larriviere J, et al. Alcohol withdrawal. Southern Medical Journal. 2012; 105(11):607–612.