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1. MANAGEMENT OF
ALCOHOL
WITHDRAWL
SEIZURE
Presented by:
Sunil Kumar Daha (Patan
Academy of Health Sciences- 1

3. PATHOGENESIS
GABAA:
• Acute intoxication: enhanced 
anticonvulsant, sleep-inducing, anti-
anxiety, muscle relaxation
• Chronic: increased no. of receptors
• Withdrawal: decreased no. of receptors
NMDA:
• Acute intoxication: diminished
• Withdrawal: enhanced action

4. CLINICAL FEATURES
Tremor
Agitation
Autonomic nervous system
overactivity:
• pulse
• respiratory rate
• sweating
• temperature
• insomnia.

5. CLINICAL FEATURES…
 Begin within 5一10h of decreasing
ethanol intake
 Peak on day 2 or 3
 Improve by day 4 or 5
 Mild problems: 4-6 months (protracted
abstinence syndrome)

6. CONCOMITTANT MEDICAL
PROBLEMS
 Additional drugs, higher alcohol
quantities
 liver failure， gastrointestinal bleeding
， cardiac arrhythmia， infection， and
glucose or electrolyte imbalances
Delirium tremens (DTs)
 Delirium (mental confusion， agitation
， and fluctuating levels of
consciousness)

7. CIWA- Ar
 Revised Clinical Institute Withdrawal
Assessment for Alcohol scale
 Centre for Addiction and Mental Health
 10 items
 Maximum score: 67
 Recorded along with time, temperature,
BP, HR, RR
 Repeated till score <10 after 3
consecutive assessments
 Carefully assess there is no re-
emergence of symptoms

18. TREATMENT
CIWA > 10
 Diazepam 20 mg PO q 1-2 hrs till
symptoms stop  Tapered in 5 days
 Observe for 1 -2 hrs after last dose
 Home medication: Diazepam 10 mg 2-3
doses
Withdrawal seizure:
 Diazepam 20 mg q 1 hr, minimum 3 doses
 Diazepam 2-5 mg IV/min – max 10-20 mg
q1 hr

19. TREATMENT
Severe liver disease, asthma, respiratory
failure
• Lorazepam SL, PO 1-2 mg tid-qid
• Oxazepam 15-30 mg PO tid-qid
Hallucination
• Haloperodol 2-5 mg PO tid-qid
Indication for hospital admission
• Still in withdrawal after 80 mg or more of
diazepam
• Delirium tremors, arrhythmias, multiple
seizures
• Other concurrent illness (800 mg/d

20. REFERENCES
 Harrison’s Principles of Internal
Medicine, 19th edition
 http://www.reseaufranco.com/en/asse
ssment_and_treatment_information/as
sessment_tools/clinical_institute_withd
rawal_assessment_for_alcohol_ciwa.p
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