Summary
The document treats alcohol withdrawal with delirium as a severe and potentially life-threatening complication that requires urgent inpatient care. Clinical assessment focuses on acute disturbance of consciousness and attention, disorientation, fluctuation in mental status, psychomotor agitation or reduced activity, perceptual disturbance, marked autonomic symptoms and seizures. The history also covers previous delirium, the amount and duration of alcohol use, the time of the last intake, coexisting illness, recent injury and use of other substances.
The protocol requires clinicians to investigate and promptly address other causes of altered consciousness, including intoxication, infection, metabolic or electrolyte disturbance, liver or kidney dysfunction, head injury, seizures and other neurological disorders. It provides for physical and neurological examination, laboratory testing, ECG and additional imaging when indicated. CIWA-Ar may be used to assess withdrawal severity when the patient can communicate reliably; when this is not possible, the RASS scale supports structured monitoring of agitation and depth of sedation.
Management includes continuous observation, a calm and safe environment, measures that support orientation, and close monitoring of breathing, circulation, temperature, fluid and electrolyte status. Prevention of thiamine deficiency and treatment of accompanying medical and neurological problems are integral to care. Medication and the target level of sedation are selected by trained staff with frequent reassessment to reduce the risks of seizures, excessive sedation, respiratory depression and cardiovascular complications. After stabilisation, clinicians assess recovery of clear consciousness, resolution of psychotic and autonomic symptoms and the safety of the next care setting. Continuing treatment for alcohol dependence and relapse prevention should follow acute care. This summary is not intended for self-treatment.