The underlying pathophysiology of AWS is CNS hyperexcitation. As such, tachycardia and hypertension are manifestations of the underlying pathology and these conditions generally respond to standard therapies targeting CNS hyperexcitation. If a patient’s symptoms and objective parameters fail to improve with escalating doses of GABAA receptor agonists (ie, benzodiazepines or barbiturates), the patient’s worsening condition may be due to benzodiazepine-resistant alcohol withdrawal or an alternative diagnosis. Patients who have had an abrupt cessation in alcohol consumption may experience a more severe withdrawal syndrome than patients who simply decrease their daily intake. In addition, previous episodes of severe withdrawal, including withdrawal seizures or DT, typically portend future episodes of severe withdrawal.
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