Pattern of alcohol withdrawal syndrome and its clinical correlates
Keywords:Alcohol withdrawal syndrome, delirium tremens, alcohol, management
Introduction and Aim: Management strategies of Alcohol Withdrawal Syndrome could be optimized if patients with greater risk are identified early and treated aggressively. Studying the pattern and predictors of alcohol withdrawal syndrome was the main objective of our study.
Materials and Methods: A total of 100 consenting male patients in the age group of 18-60 years diagnosed with alcohol dependence and uncomplicated alcohol withdrawal undergoing in-patient detoxification in tertiary care center in north India were included in the study. A semi structured proforma was used to collect socio-demographic data, Alcohol Use Disorders Identification Test (AUDIT) was used as screening tool and Clinical Institute Withdrawal Assessmentfor Alcohol-revised (CIWA- Ar) was used to assess severity of withdrawal.
Results: Symptoms like difficulty in orientation, seizures and hallucinations were relatively specific for severe AWS, while tremors and anxiety were common to all the patients and were non-specific for predicting severity of AWS. The severity of AWS symptoms correlated significantly with increasing age, duration of alcohol use and AUDIT score.
Conclusion:We concluded that increasing age, longer duration of alcohol use, higher AUDIT score and symptoms related to hallucinations, orientation and seizure are linked to severe alcohol withdrawal. Prior knowledge of these predictors will help to identify the patients at risk of severe alcohol withdrawal so that individual care can be enhanced.
World Health Organization (2014). Global status report on alcohol and health, Geneva, Switzerland.
Isbell, H., Fraser, H.F., Wikler, A.L. An experimental study of the etiology of “rum fits and delirium tremens. Q J Stud Alcohol. 1955; 16:1-33.
Sachdeva, A., Chandra, M., Deshpande, S.N. A comparative study of fixed tapering dose regimen versus symptom-triggered regimen of lorazepam for alcohol detoxification. Alcohol. 2014;49(3):287-291.
Al-Sanouri, I., Dikin, M., Soubani, A.O. Critical care aspects of alcohol abuse. South Med J. 2005; 98:372-381.
Sarff, M., Gold, J.A. Alcohol withdrawal syndromes in the intensive care unit. Crit Care Med. 2010 Sep;38(9 Suppl): S494-501.
Sachdeva, A., Choudhary, M., Chandra, M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of Clinical and Diagnostic Research 2015;9(9): VE01-VE07.
Saitz, R., Mayo-Smith, M.F., Roberts, M.S., Redmond, H.A., Bernard, D.R., Calkins, D.R. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA. 1994; 272:519-523.
Findley, J.K., Park, L.T., Siefert, C.J. Two routine blood tests-mean corpuscular volume and aspartate aminotransferase-as predictors of delirium tremens in trauma patients. J Trauma.2010; 69:199-201.
Pristach, C.A., Smith, C.M., Whitney, R.B. Alcohol withdrawal syndromes - prediction from detailed medical and drinking histories. Drug Alcohol Dependence.1983; 11:2177-2199.
Schuckit, M.A., Tipp, J.E., Reich, T., Hesselbrock, V.M., Bucholz, K.K. The histories of withdrawal convulsions and delirium tremens in 1648 alcohol dependent subjects. Addiction. 1995; 90:1335-47.
Wojnar, M., Wasilewski, D., Zmigrodzka, I., Grobel, I. Age-related differences in the course of alcohol withdrawal in hospitalized patients. Alcohol.2001; 36:6577-6583.
World Health Organization (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva, Switzerland: World Health Organization.
Saunders, J.B., Aasland, O.G., Babor, T.F., de la Fuente, J.R., Grant, M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction.1993; 88:791-804.
Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E., et al., The mini-international neuropsychiatric interview (MINI). The development and validation of a structured diagnostic psychiatric interview for DSM IV and ICD 10. J Clin Psychiatry.1998; 59(Suppl 20):22-33.
Trzepacz, P.T., Baker, R.W., Greenhouse, J.A. Symptom rating scale for delirium. Psychiatry Res. 1988; 23(1):89-97.
Folstein, M.F., Folstein, S.E., Mchugh, P.R. Mini Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res. 1975; 12(3):189-198.
Sullivan, J.T., Sykora, K., Schneiderman, J., Naranjo, C.A., Sellers, E.M. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). Br J Addict. 1989; 84:1353-1357.
DeCarolis, D.D., Rice, K.L., Ho, L., Willenbring, M.L., Cassaro, S. Symptom driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit. Pharmacotherapy. 2007;27: 510-518.
Statistical Package for the Social Services 17.0 for Windows, SPSS Inc. All rights reserved. SPSS Inc. Headquarters, 233 S. Wacker Drive, 11th floor Chicago, Illinois 60606.
Liskow, B.I., Rinck, C., Campbell, J., DeSouza, C. Alcohol withdrawal in the elderly. Journal of Studies on Alcohol. 1989; 50: 414-421.
Foy, A., Kay, J., Taylor, A. The course of alcohol withdrawal in a general hospital. Quarterly Journal of Medicine.1997;90: 253-261.
Kraemer, K.L., Mayo-Smith, M.F., Calkins, D.R. Impact of age on the severity, course, and complications of alcohol withdrawal. Archives of Internal Medicine.1997;157: 2234-2241.
Palmstierna, T. A model for predicting alcohol withdrawal delirium. Psychiatric Services.2001; 52:820-823.
Freidman, H. J. Assessment of physical dependence on and withdrawal from ethanol in animals. In H.Rigter and J.C. Crabbe, Jr (Eds.), Alcohol Tolerance and Dependence. Amsterdam: Elsevier, 1980.
Foy, A., March, S., Drinkwater, V. Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital. AlcoholClin Exp Res.1988; 12:360-364.
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