If untreated, alcohol withdrawal can lead to serious and life-threatening conditions, including grand mal seizures. According to the Journal of Family Practice, seizures can occur in up to 25 percent of alcoholics undergoing withdrawal. Treatment is intended primarily to prevent and manage serious alcohol withdrawal symptoms.
Hospitalization and Monitoring
Hospitalization in a safe medical environment equipped for detoxification is the first step in treatment. Vital signs including pulse and blood pressure are checked several times a day and any tremors, gastrointestinal discomfort or psychiatric problems are monitored daily. Nervous system excitation, including high pulse rate and elevated blood pressure, is the first sign of more serious withdrawal symptoms.
Benzodiazepines and Anti-Seizure Medications
Benzodiazepines prevent symptoms of alcohol withdrawal. Medications include diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan) and oxazepam (Serax) and can be given as needed or as a routine dose several times a day. If given as needed, this medication is administered when blood pressure and pulse are abnormally high. If given as a routine dose, it is tapered over several days and discontinued if the patent shows no signs or symptoms of withdrawal. Anti-seizure medications such as valproate (Depakote) are sometimes used in addition to prevent seizures, reducing the need for benzodiazepines, which can be addictive and thus a poor substitute for alcohol.
Delirium Tremens and Seizures
Severe tremor, confusion and hallucinations are signs of delirium tremens. Alcohol withdrawal seizures are usually grand mal seizures, involving convulsions and loss of consciousness. Treatment of delirium tremens and seizures requires transfer to an intensive care unit and intravenous hydration and higher doses of benzodiazepines. If not treated properly, these conditions can be life-threatening.
Vitamins
Alcoholics tend to substitute alcohol for food. As a result, they often have vitamin deficiencies, most notably thiamine, folate and B12. Thiamine deficiency can cause irreversible amnesia, a medical emergency that requires immediate intravenous administration of thiamine. For those who don't exhibit such symptoms, thiamine is given daily for prevention, along with vitamin B12 and folate as part of a routine withdrawal treatment.
References
- "Journal of Family Practice"; 3 regimens for alcohol withdrawal and detoxification; Chad Asplund et al.; July 2004
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry; Virginia Sadock and Pedro Ruiz (editors); 2009
