Epidemiology

  • Incidence: 50.00 cases per 100,000 person-years
  • Peak incidence: 50-60 years
  • Sex ratio: more common in males 2:1
Condition Relative
incidence
Wernicke's encephalopathy2.00
Alcohol withdrawal1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Pathophysiology

Mechanism
  • chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
  • alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)

Clinical features

Features
  • symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
  • peak incidence of seizures at 36 hours
  • peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Management

Management
  • patients with a history of complex withdrawals from alcohol (i.e. delirium tremens, seizures, blackouts) should be admitted to hospital for monitoring until withdrawals stabilised
  • first-line: benzodiazepines e.g. chlordiazepoxide. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol
  • carbamazepine also effective in treatment of alcohol withdrawal
  • phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures