Summary
This protocol addresses recognition and management of alcohol withdrawal syndrome, a group of psychological, autonomic, neurological and physical symptoms that can follow cessation or a marked reduction in prolonged alcohol use. It describes history taking, including the timing of last alcohol use, previous withdrawal episodes, seizures or delirium, coexisting illness and use of other substances. Clinical assessment includes consciousness and orientation, mental and neurological status, blood pressure, pulse, respiratory rate, temperature and signs of dehydration.
When meaningful communication with the patient is possible, severity and change over time are assessed with the standardised CIWA-Ar scale. Laboratory and instrumental investigations are selected when indicated and may evaluate liver function, fluid and electrolyte balance and cardiac status. The protocol stresses differential assessment because intoxication, infection, metabolic disturbance, injury and other medical or neurological conditions may resemble or complicate withdrawal. The care setting is chosen according to severity and risk: mild withdrawal may be managed as an outpatient, whereas severe symptoms, seizures, delirium or significant physical and neurological comorbidity require inpatient care and continuous observation.
The treatment section covers a safe environment, structured monitoring, correction of fluid and electrolyte disturbances, prevention of thiamine deficiency and medication when clinically indicated and not contraindicated. Repeated assessment is essential to identify worsening illness, respiratory compromise or excessive sedation. Once acute symptoms have resolved, the person should be connected with continuing treatment for alcohol dependence, psychological and family support, prevention of repeated withdrawal and rehabilitation. Individual prescriptions and monitoring intervals must be determined by qualified clinicians using the complete protocol and the patient’s current clinical condition.