Acute Alcohol Withdrawal
Overview
Acute alcohol withdrawal syndrome (AWS) is a potentially life-threatening condition that develops after abrupt cessation or significant reduction of heavy, prolonged alcohol use.
AWS is a common emergency department (ED) presentation and requires prompt recognition, structured assessment, and evidence-based management to prevent serious complications such as seizures, delirium tremens (DT), and Wernicke’s encephalopathy (WE).
This section outlines the assessment and management of AWS in the ED, aligned with current UK guidelines.
Distinguishing Alcohol Use Disorder (AUD) and Alcohol Withdrawal Syndrome (AWS)
It is essential to differentiate between:
- Alcohol Use Disorder (AUD): A chronic, relapsing condition characterised by compulsive alcohol use, impaired control, and negative emotional states when not drinking. Diagnosis and severity are assessed using validated tools (e.g., AUDIT, SADQ), guiding longer-term management.
- Alcohol Withdrawal Syndrome (AWS): The acute neuropsychiatric and physiological response to reduced or ceased heavy alcohol intake. AWS is the immediate clinical focus in the ED, requiring urgent intervention to prevent morbidity and mortality.
Pathophysiology
Chronic alcohol consumption leads to adaptive changes in the central nervous system, including upregulation of excitatory (glutamatergic) pathways and downregulation of inhibitory (GABAergic) pathways. Sudden cessation unmasks this imbalance, resulting in CNS hyperexcitability and the clinical features of withdrawal.