Alcohol Withdrawal Delirium

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What is alcohol withdrawal delirium?

Alcohol withdrawal delirium (AWD) is the most serious alcohol withdrawal type. AWD can cause a sudden, yet severe, problem in your nervous system including your brain.

Not less than 50 percent of those afflicted with alcohol addiction will eventually experience symptoms of withdrawal if they suddenly stop drinking. Out of this percentage, at least 3 to 5 percent will have symptoms of AWD symptoms such as severe seizures and grand mal seizures.

Causes of alcohol withdrawal delirium

Alcohol withdrawal delirium can only be experienced by chronic and heavy alcohol users. Those who drink heavily will have alcohol withdrawal delirium if they:

• Without a second thought, stop drinking
• have an existing infection
• suddenly reduce their alcohol use
• sustained a head injury
• have poor eating habit when limiting alcohol use
• are sick

Excessive drinking can both irritate and excite the nervous system. If you drink every day, your body will become addicted to alcohol with time. When your body becomes used to alcohol, your central nervous system will no longer have the capacity to readily adapt to a lack of alcohol. Alcohol affects the activities of certain chemicals called neurotransmitters in the brain.

Neurotransmitters are strictly involved in signal transmission. Plus, these chemicals, when influenced by alcohol, make you feel relaxed.  A time will come when these chemicals can no longer be influenced, that is, suppressed by alcohol. When they are suppressed, they will work very hard to overcome being suppressed. When they fail to overcome it, they will become overexcited. Failure to sustain their over-excitement when you suddenly stop taking alcohol will thus result in an alcohol withdrawal syndrome.

Who is at risk of alcohol withdrawal delirium?

You are at risk of having alcohol withdrawal delirium if:

• you have been seriously into heavy drinking for a long period of time
• you have any history of alcohol withdrawal delirium
• you have health problems combined with alcoholism
• you have a seizure disorder history or any other brain problem

All heavy, chronic drinkers are susceptible to alcohol withdrawal delirium. Heavy drinking according to the Centers for Disease Control and Prevention, has been defined as drinking 15 drinks every week for men and 8 drinks every week for women.

These are equivalent of one drink:

• 12 ounces of beer
• 8 ounces of malt liquor
• 1.5 ounces of distilled spirits (liquor) i.e. whiskey, gin, vodka, or rum
• 5 ounces of wine

Binge drinking is a notable form of heavy drinking. Women binge drink if they take 4 or more drinks at a go. For men, it will mean taking 5 or more drinks at once.

Have a talk with your doctor if you are serious into alcohol drinking. He will recommend to you, available programs that can be of help in overcoming your addiction. Your doctor won’t also fail to help you get rid of your symptoms with the right medications and therapy.

Symptoms of alcohol withdrawal delirium

Within 3 to 5 days of stopping alcohol drinking or decreasing the amount you consume, you should have AWD symptoms. This time frame is just an average. It can be more than that. Symptoms of alcohol withdrawal delirium include:

• anxiety
• irritability
• involuntary muscle contractions
• confusion
• delusions – being irrational in believing things that are not true
• excessive sweating
• eye problems
• muscle movement problems
• fatigue
• fear
• excitement
• fever
• increased heart rate
• increased startle reflex – an exaggerated reaction to an unexpected stimulus
• sudden mood changes
• increased breathing rate
• hallucinations – hearing and seeing things that aren’t there
• nausea
• delirium – a highly disturbed state of mind
• nightmares
• seizures
• stomach pain
• restlessness
• sensitivity to touch, light, or sound

Alcohol withdrawal timeline

Alcohol withdrawal symptoms can set in just about 2 hours after having your last drink.

It can also start 6 hours to a day after having your last drink. This submission is from American Family Physician guidelines. Withdrawal has four stages with their corresponding symptoms.

Stage 1: 6 to 12 hours after your last drink

This is the very first stage and it should begin showing symptoms from 6 to 12 hours after your last drink. The symptoms are usually mild.

• increased and irregular heart rate
• sweating
• anxiety
• nausea
• insomnia
• appetite loss
• headache

Stage 2: 12 to 24 hours after last drink

Alcoholic hallucinosis should set in between 12 to 24 hours after your last drink. It can continue for up to 48 hours after your last drink. The following hallucination types exist:

• tactile hallucinations i.e. having a strange sense of unreal burning, numbness or itching
• auditory hallucinations – hearing non-existing sounds
• visual hallucinations – seeing unreal images

When it’s more than 48 hours, it will be very hard to experience hallucinations after your last drink.

Stage 3: 24 to 48 hours after last drink

The symptom in this stage is seizure. It can occur several times a day.

Stage 4: 48 to 72 hours after last drink

It might take up to 5 days for the symptoms to peak. After this time, it will take another 5 or 7 days for them to wane.

How alcohol withdrawal delirium is diagnosed

Once you contact your doctor, he will review your history. He will find out from you what symptoms you are experiencing. He will also do a physical exam on you. Some of the signs that your doctor will look at are:

• dehydration
• irregular heart rate
• fever
• hand tremors

A toxicology screen to test your alcohol level in the body will be considered. Your blood or urine sample will be collected for this purpose. A toxicology screen can also diagnose the presence of other substances in your body. If your doctor recommends an inpatient treatment for you, more than one toxicology screening will likely be performed on you so as to check your alcohol level. Inpatient treatment is being treated in the hospital upon admission.

Depending on the severity of the symptom, other tests might be required.

Such tests are:

Blood magnesium level: a simple blood test will be used to assess the serum level of magnesium. A low magnesium level is an indicator that the condition is severe.

Normal magnesium levels must be maintained in the body for the normal functioning of the heart.

Blood phosphate level: alcoholism will reduce phosphate levels in the blood.

Comprehensive metabolic panel: it is usually done in a fasting state. This means you will have to fast for the test. Abnormal results will mean alcoholism is severe.

This test can also evaluate your overall kidney and liver health.

ECG: An ECG (electrocardiograph) detects abnormal electrical activities of the heart.

Arrhythmia and heart palpitations can be evaluated from an ECG.

EEG: An EEG (electroencephalogram) assesses electrical abnormalities in the brain. This will be useful in those that experience seizures as a withdrawal symptom.

The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) is nothing but a series of questions that can be used to assess not just alcohol withdrawal but its severity. The scale assesses the following ten (10) symptoms:

• anxiety
• auditory disturbances
• headache
• nausea
• agitation
• vomiting
• clouding of sensorium – inability to think straight
• paroxysmal sweats – suddenly experiencing uncontrollable sweating
• tremors
• tactile disturbances
• visual disturbances

Questions your doctor may ask include:

• Do you feel sick to your stomach?
• What day is today?
• Do you feel like you are having a band around your head?
• Who am I?
• Do you feel bugs crawling under your skin?

How alcohol withdrawal delirium is treated?

Treatments for Alcohol withdrawal delirium may include:

• medication to reduce fever and body aches
• intravenous fluids
• anticonvulsants: They are used to stop seizures from happening
• treatment for other alcohol-related conditions
• sedatives: It is used to calm agitation and control anxiety
• antipsychotic medications: They are preventive drugs for hallucinations
• rehabilitation: Its aim is to assist you in stopping your drinking habit

Alcohol withdrawal delirium can be very severe to the extent that it becomes fatal to your health. When this is the case, you will have to be admitted to the hospital as it will allow the doctor to keep an eye on you.

You might have to be under intensive care for a week or more for you to become better.

Rehabilitation is a long-term treatment plan to manage addiction to alcoholism.

Complications of alcohol withdrawal delirium

In instances of severe alcoholism and severe alcohol withdrawal, serious complications can arise and would need to be handled immediately. These will be seen in heavy alcohol users.

Other heavy drinking-related conditions that can be treated are:

Alcohol-related liver disease: This is a consequence of years of heavy drinking. The consequence is liver cirrhosis where the tissues of the liver become scarred

This can be treated with antibiotics and “water pills” to get rid of fluid build-up in your body especially your abdomen. Alcoholic liver disease when left unattended to can result in permanent liver or kidney damage.

Alcoholic cardiomyopathy: In alcoholic cardiomyopathy, there is a failure of the heart from long term alcohol use.

To treat this, the amount of sodium in the blood needs to be reduced.

Beta-blockers and ACE inhibitors can also be useful. When all these approaches have failed to rescue the heart, a heart transplant may be required.

Alcoholic neuropathy: Alcoholic neuropathy is associated with damage to the nerves of the brain due to excessive drinking. Its symptoms include tingling, painful sensations, muscle problem, and numbness. The damage to the nerves is permanent. Treatment will hence be symptoms’ management-based. Physical therapy might be needed.

Wernicke-Korsakoff syndrome: Wernicke-Korsakoff syndrome is damage to the parts of the brain namely the thalamus and hypothalamus. The part of the brain involved in memory can also be damaged completely.

Vitamin B-1 can be extremely useful in improving symptoms such as muscle-related problems.

Memory loss is mostly permanent.

People with alcohol withdrawal delirium are also susceptible to:

• injuries during a seizure fall
• injuring themselves or someone else when in a state of confusion
• developing irregular heartbeats

Outlook for alcohol withdrawal delirium

Early treatment for alcohol withdrawal delirium can often lower your risk of serious complications that can lead to death.

Certain symptoms of alcohol withdrawal could last for a year or more. These include:

• sleeplessness
• mood swings
• fatigue

Preventing alcohol withdrawal delirium

If you can stop drinking altogether, you can prevent alcohol withdrawal delirium from developing. This is the best way of actually preventing an alcohol withdrawal delirium. If you are struggling with drinking, see your doctor for help.

Don’t try to do it yourself. Engage your doctor. He is very resourceful in providing you with all the necessary information and medical help. Treat any symptoms of alcohol withdrawal as an emergency case that needs urgent attention.

Support groups for alcohol withdrawal

If you are nudging plans to decrease your alcohol dependence, do well to consult your doctor. He will have so much help to offer to you based on the status of your health.

Support groups and resources can also be accessed both online and offline. The following information will be really helpful to you:

• Rehabs.com – This site can assist you in finding rehabilitation centers closest to you

• SMART Recovery– includes both online resources and local meetings
• Alcoholics Anonymous (AA) – there are both local support chapters and online resources
• American Addiction Centers – they have online facilities and resources throughout the United States.