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Review
. 2020 Mar 19:12:53-65.
doi: 10.2147/OAEM.S235288. eCollection 2020.

Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives

Chelsea Wolf  1   2 , Ashley Curry  1   2 , Jacob Nacht  1   3 , Scott A Simpson  1   2
Affiliations
Review

Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives

Chelsea Wolf et al. Open Access Emerg Med. .

Abstract

Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and life-threatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients' AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.

Keywords: alcohol use disorder; alcohol withdrawal syndrome; benzodiazepine; delirium tremens; gabapentin; phenobarbital.

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Conflict of interest statement

SA Simpson sits on the advisory board for Impel Neuropharma and has received royalties from Taylor and Francis. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Stages of alcohol withdrawal syndrome.
Figure 2
Figure 2
Prediction of Alcohol Withdrawal Severity Scale Notes: Reproduced with permissin from Oxford University Press. Maldonado Jet al. Prospective Validation of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in medically ill inpatients: a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol Alcoholism. 2015;50(5):509–518.Abbreviations: BAL, blood alcohol level; PAWSS, Prediction of Alcohol Withdrawal Severity Scale; AA, Alcoholics Anonymous; AWS, alcohol withdrawal syndrome.
See this image and copyright information in PMC

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