BAL(mg/dl) | Clinical Features |
|---|---|
30 | Attention difficulties (mild), euphoria |
50 | Coordination problems |
100 | Ataxia, drunk driving |
200 | Confusion, decreased consciousness |
>400 | Anesthesia, coma, death |
Time of Onset | Syndrome | Clinical Features |
|---|---|---|
6-8 h | Minor withdrawal | Tremulousness/“shakes,” mild anxiety, headache, diaphoresis, palpitations, anorexia, gastrointestinal upset. |
8-12 h | Alcoholic hallucinosis | Psychotic or perceptual symptoms. |
12-24 h | Seizures | 10% of all chronic drinkers endure a grand mal seizure, with 1/3 progressing to delirium tremens. Status epilepticus uncommon; however, there may be more than one seizure 3-6 h after the first seizure. |
72 h-1 week | Delirium tremens | Autonomic instability, mild fever, insomnia. Hallucinations may be auditory of a persecutory nature or tactile. Fatality <1%. Cause of death usually infectious fat emboli or cardiac arrhythmias. |
Note: Not uncommon for patient to skip a stage and proceed from tremulousness to delirium tremens. | ||
Severe tremulousness, other autonomic symptoms, or hallucinosis.
Significant volume depletion, acid-base or electrolyte disturbance.
Fever and delirium or seizure.
Fever above 38.1°C (100.5°F).
First seizure ever or seizure without prior evaluation.
Delirium.
History of alcohol withdrawal delirium.
Wernicke encephalopathy (e.g., ataxia, nystagmus, internuclear ophthalmoplegia).
Head trauma with loss of consciousness.
Failure to respond to initial outpatient treatment.
Presence of significant comorbidity requiring hospitalization.
Decompensated liver disease
Respiratory compromise or failure
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