Intended for healthcare professionals

Practice Guidelines

Diagnosis and clinical management of alcohol related physical complications: summary of NICE guidance

BMJ 2010; 340 doi: (Published 16 June 2010) Cite this as: BMJ 2010;340:c2942
  1. Sharon Swain, senior research fellow1,
  2. Taryn Krause, senior project manager1,
  3. Phillipe Laramee, health economist1,
  4. Stephen Stewart, consultant hepatologist and honorary lecturer2
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE
  2. 2Liver Unit, Freeman Hospital, Newcastle Upon Tyne NE7 7DN
  1. Correspondence to: S Swain Sharon.swain{at}

    Continued hazardous and harmful drinking can result in dependence and tolerance, with risk of alcohol withdrawal syndrome on abrupt reduction or cessation; it may also result in damage to almost any organ or system in the body. Hazardous and harmful drinkers are commonly encountered among hospital patients, with 863 300 alcohol related admissions to hospital in 2007-8, an increase of 69% since 2002-3.1 The cost to the NHS of treating acute and chronic drinking is estimated to be as much as £2.7bn a year.2

    This article summarises recommendations made in the recent guidance from the National Institute for Health and Clinical Excellence (NICE) for the diagnosis and clinical management of alcohol related physical complications in adults and children (aged over 10 years).3 That guideline should be read in conjunction with the NICE public health guidance on the prevention and early identification of alcohol use disorders in adults and young people4 and the forthcoming NICE clinical guideline on the management of alcohol dependence and harmful alcohol use.5


    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Acute alcohol withdrawal

    Admission to hospital

    • For people in acute alcohol withdrawal with alcohol withdrawal seizures or delirium tremens, or for those at high risk (for example, those who have a history of alcohol withdrawal seizures or delirium tremens) of developing either condition, offer admission to hospital for medically assisted alcohol withdrawal. [Based on moderate quality cohort studies and observational studies]

    • For young people aged under 16 years who are in acute alcohol withdrawal, offer admission to hospital for physical and psychosocial assessment, in …

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