Alcoholontwenning

Alcoholontwenning, or alcohol withdrawal, is a set of symptoms that occur when a person with heavy, prolonged alcohol use reduces or stops drinking after a period of dependence. It results from neuroadaptation to chronic alcohol exposure and increased nervous system activity when alcohol is removed.

Onset and course: Minor symptoms can begin 6 to 12 hours after the last drink; more significant signs typically emerge 12 to 24 hours and peak within 24 to 48 hours. Delirium tremens, the most severe complication, usually develops 48 to 72 hours after the last drink. Seizures may occur within 6 to 48 hours.

Signs and symptoms: Mild symptoms include tremor, anxiety, sweating, irritability, insomnia, nausea, vomiting, and tachycardia. More severe withdrawal can involve autonomic instability, agitation, confusion, and perceptual disturbances; delirium tremens includes severe confusion, fever, and fluctuating consciousness. Seizures are possible.

Risk factors and complications: Prior withdrawal episodes, high levels of daily alcohol use, longer dependence, malnutrition or liver disease, and other illnesses increase the risk of severe withdrawal and delirium tremens. Complications include seizures, delirium tremens, dehydration, electrolyte disturbances, and, rarely, death.

Diagnosis and management: Diagnosis is clinical, sometimes guided by CIWA-Ar. Treatment aims to prevent complications and relieve symptoms. First-line therapy is benzodiazepines (such as diazepam, chlordiazepoxide, or lorazepam) titrated to severity. Thiamine is given to prevent Wernicke’s encephalopathy, followed by fluids and electrolyte correction. Severe cases may require inpatient or ICU care; after stabilization, treatment for alcohol use disorder is advised.

Prognosis and prevention: With proper treatment, withdrawal symptoms typically resolve within days. Without adequate care, complications can be life-threatening. Prevention focuses on safe withdrawal management and ongoing strategies for reducing alcohol use.