Alcohol Use Disorder (AUD)
Alcohol Use Disorder (AUD) commonly presents to emergency departments with acute intoxication, complications of chronic heavy drinking, or symptomatic withdrawal. ED management must prioritise immediate life‑threats, recognise and prevent specific complications (notably Wernicke’s encephalopathy, withdrawal seizures and delirium tremens), begin appropriate pharmacotherapy, correct metabolic and nutritional derangements, and arrange follow‑up or specialist referral (NICE CG100, CG115; RCEM toolkit).
Definition and epidemiology
- Hazardous heavy alcohol consumption: >40 g/day (males) or >30 g/day (females) (WHO).
- High prevalence: AUD affects a substantial minority of adults in many countries and contributes significantly to ED attendances and hospital admissions (NICE; national statistics).
Why it matters in the ED
- Time‑sensitive complications include aspiration, trauma, seizures, delirium tremens (DTs), Wernicke’s encephalopathy, hepatic encephalopathy, arrhythmias, infection and metabolic disturbance.
- The ED is the key point for initial stabilisation, thiamine administration, initiation of medically assisted withdrawal when indicated, and brief intervention/referral (CG100/CG115; RCEM).
Initial assessment and priorities
- Immediate priorities: follow ABCDE - protect the airway (reduced consciousness, vomiting), oxygenate, treat shock/hypovolaemia, assess level of consciousness (GCS) and focal neurology, and treat life‑threatening reversible causes (hypoglycaemia, head injury, sepsis).
- Focused history and collateral: seek last drink, pattern and amount of alcohol use, prior withdrawal seizures or DTs, comorbidities (liver disease, pregnancy, cardiac disease), current medications, nutrition and social circumstances.