Abstract

In this issue of EM Practice Guidelines Update, 3 practice guidelines that address the management of alcohol withdrawal syndrome (AWS) are reviewed. The recommendations within the 3 guidelines focus on decision-making around the management of patients who present with acute alcohol withdrawal, alcohol withdrawal seizures, and the use of benzodiazepines for AWS.

Alcohol dependence and AWS remain significant medical problems for patients who present to the emergency department (ED) as well as for admitted patients. Complications related to the use of alcohol account for a significant proportion of intensive care unit (ICU) admissions, with AWS being the most common complication. Alcohol withdrawal syndrome is a spectrum of disorders of varying significance and includes withdrawal seizures, alcoholic hallucinosis, and the most serious complication—delirium tremens. Delirium tremens was once the leading cause of mortality for patients admitted with AWS, with a mortality approaching 50%. With better understanding of the disease process as well as improvement in supportive care, mortality has decreased. Patients who present with AWS require immediate attention and specific pharmacologic intervention.

Practice Guideline Impact

• Benzodiazepines are considered the first-line treatment in the prevention and management of AWS
• In all but the mildest cases, the intravenous (IV) route should be utilized with the administration of benzodiazepines. 
• The administration of benzodiazepines should be administrated in a “symptom-triggered” fashion as opposed to a fixed-interval schedule.