Alcohol Withdrawal

Alcohol withdrawal can begin within hours after a person with physiologic dependence sharply reduces or stops drinking. Symptoms range from tremor, anxiety, nausea, and autonomic activation to seizures and delirium tremens (DTs). A measurable blood alcohol level does not exclude withdrawal when intake has recently fallen; the timing of the reduction and any history of severe withdrawal matter more than a single level. The nurse watches the trajectory, not only the CIWA-Ar number. Trend mental status, autonomic instability, seizure risk, hydration, glucose, electrolyte abnormalities, and the respiratory response to benzodiazepines. Hallucinations with preserved orientation suggest alcoholic hallucinosis; inattention, disorientation, and marked autonomic activation suggest DTs, an emergency requiring immediate escalation.