There are no particular diagnostic studies that will show a patient is in withdrawal from alcohol. Rather, AWS is a clinical diagnosis of exclusion. Diagnostic studies are useful to rule out other causes of tremor, tachycardia, hypertension, seizures, hallucinations, and delirium.
All patients with suspected moderate or severe alcohol withdrawal should have basic laboratory studies obtained, including basic serum chemistries and a complete blood count (CBC). The CBC may show leukocytosis, which may be indicative of a hyperadrenergic state or underlying infection. An elevated mean corpuscular volume (MCV) may be indicative of pernicious anemia secondary to vitamin B12 deficiency. Serum pH and osmolality tests may be indicated based on the results of the patient’s chemistries; alcoholic ketoacidosis may present with an elevated anion gap. The serum pH may be low or normal due to concomitant ketoacidosis and contraction alkalosis. Alcoholics commonly have severe electrolyte abnormalities including hypokalemia, hypomagnesemia, hyponatremia, and alcoholic ketoacidosis.
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