Alcohol Withdrawal Syndrome (AWS) - ICU OnePager



Scoring Alcohol Withdrawal Syndrome (AWS):

 • PAWSS

 • CIWA-Ar

 • AWS



Withdrawal Symptom Timeline:

 • Minor Withdrawal Symptoms (6-36 hours):

    - Tremulousness, anxiety, h/a, diaphoresis, palpitations, N/V, w/ normal mentation

 • Withdrawal Seizures (6-48 hours)

    - 1-3 usually generalized seizures

    - Status epilepticus occurs in 3%

    - High risk of progression to DTs

 • Alcoholic Hallucinosis (12-48h):

    - Visual, auditory, & tactile hallucinations, with intact orientation & normal sensorium with normal vital signs

 • Delirium Tremens (48-96h) 

    - Fluctuating cognition & attention, altered sensorium (hallucinations)

    - Autonomic instability (low grade fever, tachycardia, hypertension, diaphoresis)



Treatment:

 • Benzodiazepines

 • Barbituates

 • Propofol

 • Dexmedetomidine

 • Clonidine

 • Haloperidol

 • Baclofen & Ketamine



by Nick Mark MD @nickmmark and Mark Ramzy, DO @MRamzyDO



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