Alcoholic: Tremor and Sweating (421/1700)

A 54yo man with alcohol dependence has tremor and sweating 3days into a hosp admission for
a fx femur. He is apprehensive and fearful. What is the single most appropriate tx?

a. Acamprossate
b. Chlordiazepoxide
c. Lorazepam
d. Lofexidine
e. Procyclidine






























answer: B

Alcohol Withdrawal
• occurs within 12-48 h after prolonged heavy drinking and can be life-threatening
• alcohol withdrawal can be described as having 4 stages, however not all stages may be experienced
stage 1 (onset 12-18 h after last drink): “the shakes” tremor, sweating, agitation, anorexia, cramps, diarrhea, sleep disturbance
stage 2 (onset 7-38 h): alcohol withdrawal seizures, usually tonic-clonic, nonfocal and brief
stage 3 (onset 48 h): visual, auditory, olfactory or tactile hallucinations

stage 4 (onset 3-5 d): delirium tremens, confusion, delusions, hallucinations, agitation, tremors, autonomic hyperactivity (fever, tachycardia, HTN)
• course: almost completely reversible in young; elderly often left with cognitive deficits



Treatment of Acute Alcohol Withdrawal (NICE)

Offer drug treatment for the symptoms of acute alcohol withdrawal, as follows:

• Consider offering a Benzodiazepine: diazepam/Chlordiazepoxide or carbamazepine.
• Clomethiazole may be offered as an alternative to diazepam or carbamazepine. However, it should be used with caution, in inpatient settings only and according to the summary of product characteristics (SPC).

Treatment for delirium tremens or seizures

• Offer oral lorazepam as first-line treatment for delirium tremens. If symptoms persist or oral medication is declined, give parenteral lorazepam, haloperidol or olanzapine.

Maintain abstinence after withdrawal
1st line: acamprosate or oral naltrexone
2nd line: disulfram