Tests
1st tests to order
BUN and serum creatinine
Test
Dehydration may occur in a delirious patient, or a patient too nauseated to hydrate themselves, and may lead to impaired renal function.
Uremic encephalopathy can mimic alcohol withdrawal delirium because of change in mental status.
Result
elevated or normal
LFTs
Test
Test liver function (including alanine aminotransferase [ALT] and aspartate aminotransferase [AST] and gamma glutamyltransferase [GGT]) in all patients with signs or symptoms of alcohol withdrawal.[5][62] May suggest excessive alcohol consumption or other diagnoses such as alcoholic hepatitis.[43][62] Impaired hepatic function may necessitate dose adjustment of medications.[5]
Result
parameters may be elevated or normal
ethanol concentration
Test
A blood or breath ethanol or ethyl glucuronide urine test may suggest recent alcohol use in those unable to communicate or give an accurate alcohol history.[5] Patients who develop acute alcohol withdrawal syndrome (AWS) with elevated blood or breath ethanol concentrations may be at higher risk for severe AWS.[63] An elevated blood alcohol level in a patient who is not demonstrably intoxicated is a risk factor for alcohol withdrawal.[5]
Result
positive for ethanol
electrolyte panel
Test
Including lactic acid level. Lactic acidosis may be related to alcohol withdrawal seizures, ketoacidosis, or ingestion of other alcohols.
Hypokalemia has been associated with development of severe alcohol withdrawal syndrome and alcohol withdrawal delirium.[42]
Result
metabolic acidosis; may also detect hypokalemia
CBC
Test
Nonspecific marker for infection, anemia, general health.
Result
WBC normal or elevated (in infection). MCV may be elevated in chronic alcohol use.
Tests to consider
CT of head
Test
To exclude intracranial causes of the clinical presentation if indicated.
Result
likely normal
chest x-ray
Test
To exclude cardiopulmonary causes of the clinical presentation if indicated.
Result
likely normal
electroencephalogram (EEG)
Test
If a patient presents with new-onset seizures, or there is a new pattern of seizures in a patient with a known history of withdrawal seizures, to rule out other causes of seizure activity.[5]
Result
likely normal
blood-borne virus screen
Test
To identify medical conditions with a high rate of co-occurrence with alcohol withdrawal such as hepatitis or HIV.
Result
positive if hepatitis or HIV present
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