Alcohol Withdrawal


  • common and can be fatal
  • manifests within 48 hours of stopping drinking


Stage I – 6-24 hrs

  • anxiety
  • restlessness
  • decreased attention
  • tremulousness
  • insomnia
  • craving

Stage II – 24 hrs

  • hallucinations (visual, auditory, tactile)
  • misperceptions
  • irritability
  • vivid dreams
  • confused
  • hypervigilant

Stage III – 48 hrs

  • generalised tonic-clonic seizures

Stage IV – after 48 hrs

  • global confusional state
  • autonomic hyperactivity
  • tremors
  • hallucinations
  • seizures
  • hyperadrenergic: diaphoresis, flushing, mydriasis, tachycardia, hypertension, low-grade fever


  • macrocytosis without anaemia


  • quite environment
  • frequent verbal orientation
  • reassurance


  • secure airway if prolonged seizure activity or not protecting airway
  • clonidine to decrease autonomic symptoms
  • beta-blockers generally not advised but can be used in selected cases
  • benzodiazepines for seizure control

Acid-base and Electrolytes

  • thiamine
  • Magnesium and other deficiencies associated with chronic alcohol abuse

Specific Treatment

  • goal = achieve light sedation to abate withdrawal symptoms, provide relief and protect patient.
  • benzodiazepines (midazolam, diazepam)
  • barbiturates
  • propofol if intubated

Underlying Cause

  • stop intake

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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