Overview
Alcohol withdrawal delirium (delirium tremens) is a severe manifestation of alcohol withdrawal syndrome characterized by altered mental status and autonomic hyperactivity. It represents a medical emergency with significant morbidity and mortality if untreated.Diagnosis
The Clinical Institute Withdrawal Assessment for Alcohol - Revised (CIWA-Ar) scale can be used to objectively follow the course of alcohol withdrawal syndrome 2.
CIWA-Ar scores are expected to decrease over time with effective treatment 2.Management
Pharmacotherapies, including benzodiazepines and non-benzodiazepines, are used to manage alcohol withdrawal 12.
Fixed-schedule administration of benzodiazepines (diazepam, lorazepam, chlordiazepoxide) and chlormethiazole were superior to placebo in reducing incident seizures 1.
Fixed-schedule diazepam was also found to reduce incident delirium tremens 1.
Non-benzodiazepine therapy has shown similar effectiveness to benzodiazepine treatment based on CIWA-Ar scores 2.
Oxcarbazepine and carbamazepine may reduce AW severity scores 1.Key Recommendations
Fixed-schedule diazepam may reduce the incidence of delirium tremens 1. (Evidence: Strong)
Benzodiazepines (diazepam, lorazepam, chlordiazepoxide) and chlormethiazole administered on a fixed schedule are effective in reducing alcohol withdrawal seizures 1. (Evidence: Strong)
Non-benzodiazepine therapies appear to be similarly effective to benzodiazepines in managing alcohol withdrawal based on CIWA-Ar scores 2. (Evidence: Moderate)References
1 Bahji A, Bach P, Danilewitz M, Crockford D, El-Guebaly N, Devoe DJ et al.. Comparative efficacy and safety of pharmacotherapies for alcohol withdrawal: a systematic review and network meta-analysis. Addiction (Abingdon, England) 2022. link
2 Pribék IK, Kovács I, Kádár BK, Kovács CS, Richman MJ, Janka Z et al.. Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol - Revised: A systematic review-based meta-analysis. Drug and alcohol dependence 2021. link