A Organização Mundial da Saúde (OMS) estima que 43% da população mundial consumam álcool, sendo que 18.2% dos consumidores de bebidas alcoólicas têm mais de 15 anos de idade e envolvem-se com consumo episódico excessivo de bebidas alcoólicas.[13]World Health Organization. Global status report on alcohol and health 2018. Sep 2018 [internet publication].
https://www.who.int/publications/i/item/9789241565639
Em 2016, a prevalência global dos transtornos decorrentes do uso de bebidas alcoólicas, definido como uso prejudicial de álcool ou dependência alcoólica, foi de 5.1% entre os consumidores com mais de 15 anos.[13]World Health Organization. Global status report on alcohol and health 2018. Sep 2018 [internet publication].
https://www.who.int/publications/i/item/9789241565639
Nos EUA, a National Survey on Drug Use and Health de 2020 relatou que 10.3% dos adultos com mais de 26 anos, 15.6% dos adultos entre 18 e 25 anos e 2.8% dos jovens (entre 12 e 17 anos) sofrem de transtornos decorrentes do uso de bebidas alcoólicas.[14]US Department of Health and Human Services: Substance Abuse and Mental Health Services Administration (SAMHSA). Reports and detailed tables from the 2020 National survey on drug use and health (NSDUH). Oct 2021 [internet publication].
https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2020-nsduh-2020-ds0001
Estima-se que destes pacientes com dependência alcoólica, aproximadamente 50% terão sintomas de abstinência alcoólica com a redução do consumo de álcool.[11]Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014 Nov 27;371(22):2109-13.
http://www.ncbi.nlm.nih.gov/pubmed/25427113?tool=bestpractice.com
[15]Schmidt KJ, Doshi MR, Holzhausen JM, et al. Treatment of severe alcohol withdrawal. Ann Pharmacother. 2016 May;50(5):389-401.
http://www.ncbi.nlm.nih.gov/pubmed/26861990?tool=bestpractice.com
Aproximadamente 8% de todos os pacientes internados nos hospitais correm risco de abstinência alcoólica.[16]Foy A, Kay J. The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population. Drug Alcohol Rev. 1995;14(1):49-54.
http://www.ncbi.nlm.nih.gov/pubmed/16203295?tool=bestpractice.com
[17]Foy A. Alcohol problems in a general hospital. Addict Biol. 1999;4(1):23-34.
http://www.ncbi.nlm.nih.gov/pubmed/20575767?tool=bestpractice.com
Entre os pacientes de unidades de terapia intensiva (UTI), alguns estudos mostraram que 16% a 31% correm risco de abstinência alcoólica; 31% dos pacientes de trauma podem correr risco de abstinência alcoólica.[18]Dixit D, Endicott J, Burry L, et al. Management of acute alcohol withdrawal syndrome in critically ill patients. Pharmacotherapy. 2016 Jul;36(7):797-822.
http://www.ncbi.nlm.nih.gov/pubmed/27196747?tool=bestpractice.com
[19]Uusaro A, Parviainen I, Tenhunen JJ, et al. The proportion of intensive care unit admissions related to alcohol use: a prospective cohort study. Acta Anaesthesiol Scand. 2005 Oct;49(9):1236-40.
http://www.ncbi.nlm.nih.gov/pubmed/16146458?tool=bestpractice.com
[20]Ungur LA, Neuner B, John S, et al. Prevention and therapy of alcohol withdrawal on intensive care units: systematic review of controlled trials. Alcohol Clin Exp Res. 2013 Apr;37(4):675-86.
http://www.ncbi.nlm.nih.gov/pubmed/23550610?tool=bestpractice.com
[21]Lukan JK, Reed DN Jr, Looney SW, et al. Risk factors for delirium tremens in trauma patients. J Trauma. 2002 Nov;53(5):901-6.
http://www.ncbi.nlm.nih.gov/pubmed/12435941?tool=bestpractice.com
Em estudos subsequentes, a incidência da síndrome da abstinência alcoólica (SAA) entre pacientes de trauma foi inferior a 1%.[22]Jawa RS, Stothert JC, Shostrom VK, et al. Alcohol withdrawal syndrome in admitted trauma patients. Am J Surg. 2014 Nov;208(5):781-7.
http://www.ncbi.nlm.nih.gov/pubmed/25062967?tool=bestpractice.com
[23]Salottolo K, McGuire E, Mains CW, et al. Occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens following traumatic injury. Crit Care Med. 2017 May;45(5):867-74.
http://www.ncbi.nlm.nih.gov/pubmed/28266937?tool=bestpractice.com
Entretanto, a maioria dos pacientes de trauma com SAA (53%) já enfrentou SAA intensa, incluindo delirium por abstinência alcoólica (11%).[23]Salottolo K, McGuire E, Mains CW, et al. Occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens following traumatic injury. Crit Care Med. 2017 May;45(5):867-74.
http://www.ncbi.nlm.nih.gov/pubmed/28266937?tool=bestpractice.com
Até 25% dos pacientes com SAA apresentaram alucinações, e cerca de 10% dos pacientes tiveram convulsões.[24]Gold JA, Nelson LS. Chapter 81: ethanol withdrawal. In: Hoffman RS, Howland MA, Lewin NA, et al, eds. Goldfrank’s toxicologic emergencies, 10th edition. Columbus, OH: McGraw Hill Professional; 2015:1108-13. Se a SAA não for tratada ou for tratada de forma inadequada, em 5% dos pacientes evoluirá para delirium por abstinência alcoólica (também conhecido como delirium tremens), geralmente 48-72 horas após a última dose.[11]Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014 Nov 27;371(22):2109-13.
http://www.ncbi.nlm.nih.gov/pubmed/25427113?tool=bestpractice.com
[25]Stehman CR, Mycyk MB. A rational approach to the treatment of alcohol withdrawal in the ED. Am J Emerg Med. 2013 Apr;31(4):734-42.
http://www.ncbi.nlm.nih.gov/pubmed/23399338?tool=bestpractice.com
[26]Sarff M, Gold JA. Alcohol withdrawal syndromes in the intensive care unit. Crit Care Med. 2010 Sep;38(9 Suppl):S494-501.
http://www.ncbi.nlm.nih.gov/pubmed/20724883?tool=bestpractice.com
A mortalidade relacionada ao delirium por abstinência alcoólica é inferior a 1% se o tratamento precoce e adequado for oferecido.[11]Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014 Nov 27;371(22):2109-13.
http://www.ncbi.nlm.nih.gov/pubmed/25427113?tool=bestpractice.com
[16]Foy A, Kay J. The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population. Drug Alcohol Rev. 1995;14(1):49-54.
http://www.ncbi.nlm.nih.gov/pubmed/16203295?tool=bestpractice.com