title: The course of alcohol withdrawal in a general hospital.
abstract: We conducted an observational study of 539 episodes of alcohol withdrawal in a general hospital, to determine the natural history, the incidences of seizures, hallucinations and delirium, and the risk factors for these events. The reaction began soon after arrival, at a median time of 5 h, and resolved at a median time of 22 h. Patients with a blood alcohol level of zero were in withdrawal on arrival, and only four patients had reactions lasting 120 h or longer. Complications were observed in 113 patients (21%) during the admission. Seizures occurred on arrival, hallucinations usually in the first 24 h and delirium in the first 48 h. No mortality was associated with alcohol withdrawal itself, but complications did extend length of stay by a median of 4 days, with delirium contributing most to the increase. Patients over 70 years of age or admitted with seizures had an increased risk of complication, but the greatest risk was associated with a delay in assessment of > 24 h. We conclude that in general hospitals, the alcohol withdrawal reaction becomes established very early, and detection and monitoring of patients within the first 24 h is the most important element in management.
authors.affiliation: General Medicine Unit, Newcastle Mater Misericordiae Hospital, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Foy
authors.forename: J
authors.initials: J
authors.lastname: Kay
authors.forename: A
authors.initials: A
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000430:Alcohol Withdrawal Delirium; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006212:Hallucinations / Q000139:chemically induced; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011446:Prospective Studies; D012640:Seizures / Q000139:chemically induced; D013375:Substance Withdrawal Syndrome / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000431:Ethanol