Case history

Case history

A 45-year-old man presents to the emergency department with restlessness and tremors. He is anxious and pacing in the hallway. Initial vital signs show a heart rate of 121 beats per minute and blood pressure of 169/104 mmHg; other vital signs are normal. On further questioning by the nurse he states that he is nauseous and wants something to help with 'the shakes'. During the consultation the patient admits to heavy alcohol use and that he is trying to cut down on drinking. He also says that his current symptoms started to develop about 6 hours after his last drink.

Other presentations

Common symptoms of alcohol withdrawal include anxiety, nausea or vomiting, autonomic dysfunction, and insomnia.[1][2][3]

Mild to moderate withdrawal symptoms may start as early as 6 to 24 hours after the patient's last alcoholic drink, and peak at 24 to 36 hours.[2]​​[4][5][7]​​ Alcohol withdrawal delirium (also known as delirium tremens) is a life-threatening feature of severe alcohol withdrawal and generally occurs 48 to 72 hours after the last alcoholic drink, and peaks at 5 days.[7]​ Alcohol withdrawal delirium is characterised by hallucinations, delusions, profound confusion and delirium, coarse tremor, and features of clinical instability.[8][9][10]​ Alcohol withdrawal seizures are also a feature of severe withdrawal, and normally occur in the first 12 to 24 hours after the last alcoholic drink.[10]

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