What interventions are safe and effective for the management of alcohol withdrawal, including treatment for alcohol withdrawal seizures and prevention and treatment for acute Wernicke's encephalopathy? Alcohol withdrawal can be uncomfortable and occasionally life-threatening. Pharmacological management of alcohol withdrawal is an essential component of alcohol dependence. Benzodiazepines (BZDs), non-sedating anticonvulsants, and antipsychotics are commonly used in the treatment of alcohol withdrawal.  Given that they are all potentially toxic medications, what is the evidence that the benefits of their use justify the risks? Which is more effective? Below, I summarize the  WHO 2012 Guidelines to treat Alcohol Withdrawal that explains the answers to these questions. 

Clinical Vignette: Preventing Complication in A Man with Agitation A 30-year-old man, who is a heavy alcohol drinker, presented to the emergency department with agitation, altered sensorium, marked tremors, visual hallucinations. On assessment, he is unaware of the time, place, and person. His blood pressure and pulse were 160/11 and 115/min on arrival but fluctuated on monitoring. A GP had given him haloperidol IM and diazepam IV to control his behavioral disturbance.  What treatment-complication could arise? a)        Seizures b)       Over-sedation c)        Respiratory depression d)       Arrhythmia e)        Worsening agitation Benzodiazepines for the Treatment of Catatonia Safest Treatment Option for Delirium Tremens WHO Alcohol Withdrawal Treatment Guidelines

Delirium Tremens Delirium Tremens is an emergent situation, that we may regard as the most severe form of alcohol withdrawal syndrome. In most cases, it occurs after long-term heavy use. It may also occur in patients who stop benzodiazepines.  In most cases, it occurs after long-term heavy use of alcohol.  Presentation Psychological and behavioural manifestations Rapidly changing picture Clouding of Consciousness Disorientation Disorganised mental activity Short term memory disturbance Perceptual abnormalities Hallucinations Visual misinterpretations Illusions Cocaine bugs (formication) Behavioural manifestations Agitation Shouting Restlessness Fear Sleeplessness  Physical Manifestations General Physical Dehydration Electrolyte disturbances Autonomic Manifestations Autonomic manifestations of delirium tremens differentiate it from delirium (acute confusional state) that occurs because of organic causes other than substance use and alcohol withdrawal.  Sweating  Fever tachycardia Raised