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Alcohol withdrawal and delirium tremens

Syndroma abstinentiae alcoholicae et delirium tremens · Alkoholový odvykací stav a delirium tremens

What it is

When heavy drinking stops, the brain — adapted to alcohol — becomes overexcited: tremor within hours, seizures within one to two days, and in about 5% delirium tremens, deadly if untreated.

Symptoms & signs

  • Tremor, sweating, anxiety, nausea (6–24 h)
  • seizures (12–48 h)
  • hallucinations
  • delirium tremens: confusion, fever, racing heart (2–4 days)
  • Wernicke's encephalopathy: confusion, eye palsies, unsteadiness

🚩 Get help if…

  • call 112 / 911 now A seizure after stopping or cutting down drinking
  • call 112 / 911 now Confusion, seeing or hearing things, severe shaking and sweating
  • call 112 / 911 now Fever, racing heart or chest pain during withdrawal
  • see a doctor soon Shakes, sweats or vomiting within a day of the last drink

Where it strikes

Medical treatment

  • Symptom scoring (CIWA-Ar)
  • Benzodiazepines (chlordiazepoxide, diazepam; lorazepam if the liver fails) — prevent seizures and delirium trials support
  • thiamine, high-dose intravenous if Wernicke's is suspected, before glucose
  • phenobarbital as an alternative
  • fluids, potassium, magnesium
  • relapse prevention: acamprosate, naltrexone, disulfiram

Natural & lifestyle

  • Never stop suddenly alone after heavy daily drinking — detox under supervision
  • nutrition
  • Alcoholics Anonymous — Cochrane 2020: more sustained abstinence trials support

Emerging & experimental

  • Baclofen — trials disagree mixed evidence
  • gabapentin
  • dexmedetomidine as an add-on in intensive care

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Acupuncture — no benefit in withdrawal trials not confirmed in trials
  • Kudzu root — small trials cut drinking early / small studies
  • Milk thistle — no proven benefit for the liver mixed evidence

ICD codes