Primary prevention

Identify patients at risk of alcohol withdrawal early.

  • Screen patients for alcohol-use disorder using a formal assessment tool such as AUDIT-C ( Alcohol Use Disorders Identification Test - Consumption Opens in new window), FAST ( Fast Alcohol Screening Test Opens in new window), or PAT ( Paddington Alcohol Test 2011 Opens in new window).[2]The full AUDIT ( Alcohol Use Disorders Identification Test Opens in new window) may also be used, but it takes longer to perform than the other screening tools and therefore may not be suitable in an acute hospital setting.[2] Abbreviated versions of AUDIT, such as AUDIT-C and FAST, were developed for use in acute settings where the full AUDIT would take too long to perform. These compare favourably with the full screening tool.

  • Identify patients who have tested positive for alcohol misuse and are at risk of alcohol withdrawal by assessing their level of alcohol dependence. AUDIT-C, FAST, PAT, and AUDIT only identify alcohol-use disorder and do not predict which patients are at risk of alcohol withdrawal. Decide which screening tool to use based on local protocols and your preference.

    • Use either SAD-Q or the CAGE questionnaire.[3][5][32]

    • In addition, ask about any history of alcohol withdrawal syndrome (and the degree of severity, such as seizures, alcohol withdrawal delirium [also known as delirium tremens], etc.).

Monitor patients at risk of alcohol withdrawal using CIWA-Ar ( Clinical Institute Withdrawal Assessment of Alcohol, revised Opens in new window) or GMAWS ( Glasgow Modified Alcohol Withdrawal Scale Opens in new window).

  • Give supportive care and thiamine replacement to all patients.

  • Give drug treatment to all patients with alcohol withdrawal and CIWA-Ar score ≥10 or GMAWS ≥2.[3][33]

  • Patients with mild to moderate alcohol withdrawal symptoms (CIWA-Ar score < 10 or GMAWS <2) can generally be managed with supportive care only.[3]

Consider admission to hospital in:[1][32]

  • Young people (under 16 years)

  • Those at high risk of developing alcohol withdrawal seizures or alcohol withdrawal delirium. These patients typically have at least one of:

    • A score >30 on SAD-Q

    • Alcohol intake >30 units of alcohol per day

    • Signs and symptoms of autonomic overactivity (e.g., tremor, tachycardia sweating, or palpitations)

    • Signs of intoxication.

Secondary prevention

Identify any patient with features of alcohol withdrawal early and start treatment (if needed) promptly to prevent severe alcohol withdrawal, including alcohol withdrawal delirium. Give supportive care and thiamine replacement to decrease the risk of alcohol-related complications.[193]

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