20th February 2024

Clinical presentation

Alcohol withdrawal symptoms exist within on a spectrum from mild symptoms up to delirium tremens. The patient usually presents with autonomic dysfunction, and symptom onset begins 6 hours after alcohol cessation. The condition’s progression depends on the overall amount of alcohol intake and period of alcohol dependence. 

Mild symptoms typically present with anxiety, headaches, palpitations and GI symptoms (nausea, vomiting). Patients can be seen pacing around due to anxiety and heightened awareness. Patients may also experience diaphoresis and tremors. 

Moderate symptoms typically include hallucinations and withdrawal seizures. Patients may experience auditory, tactile or visual hallucinations, which typically present 24-48 hours following cessation of alcohol. Seizures that occur in this context typically present as a generalised tonic-clonic seizure. The most severe presentation of alcohol withdrawal is delirium tremens. Delirium tremens is characterised by significant autonomic dysfunction with changes in vital observations. Patients typically experience tachycardia, hypertension, hyperthermia, agitation, diaphoresis, seizures and profound confusion.