Alcohol withdrawal

Revision as of 17:23, 5 April 2011 by Jswartz (talk | contribs)


  • Withdrawal symptoms due to reduced GABA pathway and increased glutamate transmission
  • Benzos useful due to cross tolerance at ethanol GABA receptor (same place carbemazipine and valproate also work
  • Symptom Triggered Tx- quantify sx and give meds upon reaching threshold- as effective as fixed dose tx and needs less drug and get more rapid detox


  • Sweating, anxiety, tremor, hallucinations, N/V, HA, visual disturbance, disorientation
  • Alcohol withdrawal symptoms peak in 72 hrs


  • Do not need meds for more than 7 days unless have DT's
  • Banana Bag
    • Thiamine 100mg IV
    • Folate 1mg IV (cheaper PO)
    • MVI 1 tab IV (cheaper PO)
    • Magnesium sulfate 2mg IV
    • NS 1L IV
  • Benzodiazapines PRN
    • Valium 5-10mg IV or Ativan 2-4mg IV Q10min until no tremor, then Q1hr
    • Valium quicker to theraputic CNS levels
  • Dilantin
  • Consider in non-classic cases


- benzos- decrease severity of sx, sz, dt

- anticonvulsants- same

- beta blockers- improve vital signs and reduce craving

- alpha agonists- decrease severity of sxs

Adjuvant Txs- not sole txs but for combination

- phenothiazines- reduce signs and sxs but less effective than benzos for sz and dt

- beta blockers/ clonidine- no sz protection, not for benzo wd

Anticonvulsants - dilantin no role

- carb- less emotional distress and has anti sz prop too, does not inhibit mem like benzos, less abuse potential

o can have dizzy, n/v

o not for dts

o has fewer protracted sxs than benzos, less relapse, less side effect

- carb may be used for benzo wd

- valproate- also useful


  • Admit:
    • Status
    • DTs
    • Focal/first sz
    • Decr loc
    • Inability to control withdrawal
  • Consider D/C with 3 day course if want to quit

See Also

Beer Potomania Syndrome

Alcohol (ETOH) Intoxication