Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal Syndrome (Substance Use Disorders CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: November 2025 (Volume 27, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 11/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Substance Use Disorders CME credits and 4 Pharmacology CME credits, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

Alcohol withdrawal syndrome is a constellation of symptoms and signs resulting from the abrupt decrease or cessation of heavy alcohol use. Complications of alcohol withdrawal syndrome present significant dangers for patient morbidity and mortality, as well as burdens on emergency department resources. This review presents an overview of the pathophysiology of alcohol withdrawal syndrome and a systematic approach for management in the emergency department. Current evidence on treatment regimens and adjunctive therapies is reviewed, and recommendations for management of patients with alcohol use disorders are discussed.

Case Presentations

A 42-year-old man presents to the emergency department by ambulance with a seizure witnessed by bystanders…

• He said he consumes about a fifth (750 mL) of whisky daily, and he says he has a history of alcohol withdrawal seizures. His last drink was about 24 hours ago.
• EMS checked his fingerstick blood glucose, which was normal, and administered 1 liter of IV 0.9% saline.
• His heart rate is 120 beats/min and his blood pressure is 163/92 mm Hg. He is oriented, but tremulous, anxious, and sweating.
• You consider your options to help control his symptoms quickly and prevent a repeat seizure...

52-year-old man presents altered to the ED, but now he is attempting to leave…

• EMS transported him to the ED after reports of a man stumbling into the middle of traffic.
• You see a malnourished-looking man attempting to get out of the stretcher, swaying back and forth.
• His vital signs are unattainable, but he appears diaphoretic, altered, and his extremities are hot to the touch. He is moaning, “No, no, no,” and grasping at the air.
• You note in his records that he was seen for alcohol intoxication and a fall 4 days prior. His head and cervical spine CT scans were negative.
• You consider whether this patient has capacity, and what your best next steps would be...

30-year old woman is signed out to you for time to metabolize alcohol …

• She says she normally imbibes 2 bottles of wine a day, and her last drink was about 12 hours ago.
• She has a history of withdrawal, but no hospitalizations for seizures or hallucinations.
• After 4 hours into your shift, the nurse informs you that the patient’s CIWA-Ar is 7, she is feeling anxious, and wishes to discuss detoxification options with you. To prepare for the discussion, you review the options for outpatient care resources you can offer, in order to prevent further withdrawal, and control her cravings...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.