Thank you Dr. Christina Chung for an excellent presentation on alcohol withdrawal syndrome in a patient with altered mental status.

Key Learning Points:

• Mild EtOH withdrawal symptoms can begin as early as six hours after last drink
• The classic tremor seen in EtOH withdrawal is an intention tremor that is constant and does not fatigue
• Severe withdrawal symptoms in the setting of elevated Ethanol levels is a risk factor for development of Delirium Tremens
• Remember: supportive care is critical and includes thiamine infusion (before glucose administration) to prevent complications of acute Wernicke Encephalopathy (characterized by triad of nystagmus, ataxia, and confusion).

For additional reading about the management of withdrawal delirium, see NEJM 2014 – Recognition & Management of Withdrawal Delirium (Delirium Tremens)