Stages of Alcohol Withdrawal

Introduction

Today we will go back to the basics and review symptoms, duration and basic physiology of alcohol withdrawal. Alcohol withdrawal occurs when there is an abrupt reduction or cessation of alcohol use, primarily due to imbalance between GABA and NDMA receptors. Alcohol, generally considered a depressant, enhances the inhibitory actions of GABA receptors and inhibits the excitatory NDMA (glutamate) receptors. After exposure to frequent or high doses of alcohol, the loss of the GABA inhibition leads to glutaminergic overactivity and a hyperadrenergic state. This is the basis of alcohol withdrawal.

Mild Withdrawal Symptoms

Onset 6-8 hours after last drink, lasting approximately 36 hours.
Symptoms: anxiety, sweating, irritability, tremors, agitation, nausea/vomiting, normal mental status

Alcohol Hallucinosis

Onset 12-24 hours after last drink, lasting approximately 48 hours
Symptoms: Hallucinations that are predominantly auditory, however can include visual and tactile as well. Can occur with or without other alcohol withdrawal symptoms. Other than hallucinations, mental status is generally clear. Not to be confused with DT’s

Alcohol Withdrawal Seizures

Onset 8-24 hours after last drink, lasting up to 5 days
Symptoms: Tonic-clonic seizures, rarely status epilepticus

Delirium Tremens

Onset 2-4 days after last drink, lasting up to 7 days
Symptoms: fluctuating level of consciousness, visual and auditory hallucinations, autonomic instability, hyperpyrexia (high fever)