Abstract
Introduction: Alcohol use disorder (AUD) is anticipated to affect about eighteen percent of the population and five percent yearly. Furthermore, it has been suggested that about twenty percent of adults in the emergency department have AUD and that the incidence of alcohol withdrawal syndrome (AWS) in patients admitted to surgical Intensive Care Unit (ICU) varies from eight to forty percent, and most likely to be linked to infectious complications and have a higher mortality rate. It is estimated that up to fifty percent of AUD patients will experience withdrawal symptoms, a minority of whom needs management. AWS represents a clinical condition recognized by symptoms of autonomic hyperactivity like agitation, tremors, irritability, anxiety, hyperreflexia, confusion, hypertension, tachycardia, fever and diaphoresis. AWS often presents in alcoholdependent patients within six to twenty four hours after the sudden stop or reduction of alcohol intake. It is highly life-threatening condition. The severity can range from mild/moderate forms characterized by tremors, nausea, anxiety, and depression, to severe forms recognized by hallucinations, seizures, delirium tremens and coma. The mild-moderate form of AWS is usually self-managed by patients or symptoms improves within two to seven days from the last drink, whereas the more severe AWS needs medical treatment. The recognition and further management of AWS is of great clinical value, as AWS is one of the causes of morbidity and mortality.
Aim of work: In this review, we will discuss Alcohol withdrawal syndrome, manifestation and management
Methodology: We did a systematic search for alcohol withdrawal syndrome, manifestation and management using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). We only included full articles.
Conclusions: AWS exemplifies a possibly life-threatening medical illness usually affecting AUD patients suddenly reducing or stopping alcohol intake. AWS should be considered in the differential diagnosis of any patients presenting with symptoms of autonomic hyperactivity. The use of a clinician-administered scale (CIWA-Ar or Alcohol Withdrawal Scale) is of great value to diagnose AWS and start adequate treatment. BZDs represent the gold standard treatment as a result both for their high rate of efficacy and being the only medications with proven ability to prevent the complicated forms of AWS (seizures, DTs). The management of AWS may be difficult. The primary phase is recognized by patient agitation and non-collaboration. This phase should be managed aggressively, to decrease the risk of medical complications (seizures, DTs, death), decrease patient suffering and improve quality of life. The direct effect of these measures will be, in most of cases, a strong physician-patient relationship. The latter is essential to enhance patient's disposition toward medical management and to start a long-term, multidisciplinary treatment of alcohol dependence. While BZD's addictive characteristics limit their long-term use, the possibility of using other medications able to be effective both for the management of AWS and the further long-term program for alcohol relapse prevention represents an advantage, i. e. carbamazepine, SMO, baclofen, gabapentin and topiramate. The initial administration of a non-BZD agent together with gold-standard treatments represents a useful choice to reduce the need for extra-dose BZD prescription (BZD-sparing drugs) and to start a medication with anti-craving characteristics. But it is highly essential to keep in mind that at present, BZDs are the most effective and manageable medications for the management of AWS.