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  1. Education
  2. Alcohol withdrawal
  3. Alcohol withdrawal
Practice BMJ Best Practice

Alcohol withdrawal

BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p951 (Published 31 May 2023) Cite this as: BMJ 2023;381:p951
  1. Alexander Alexiou, emergency medicine consultant, physician response unit consultant12,
  2. Thomas King, locum consultant emergency medicine, senior fellow physician response unit1 2
  1. 1Barts Health NHS Trust, London, UK
  2. 2London’s Air Ambulance, Royal London Hospital, London
  1. Correspondence to asalexiou{at}gmail.com

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What you need to know

  • Suspect acute or imminent alcohol withdrawal in any patient who is alcohol dependent and has stopped or reduced their alcohol intake within hours or days of presentation

  • Common symptoms include anxiety, nausea or vomiting, autonomic dysfunction, and insomnia. These may progress to severe withdrawal with seizures and alcohol withdrawal delirium

  • Alcohol withdrawal delirium is a life threatening medical emergency that requires urgent treatment with a benzodiazepine. Involve senior support and critical care

  • Not all patients with symptoms of alcohol withdrawal will need acute drug treatment; those with mild to moderate alcohol withdrawal symptoms can generally be managed with supportive care only

  • Start a benzodiazepine regimen (fixed dose or symptom triggered, depending on the clinical setting) for any patient needing acute drug treatment

Alcohol withdrawal occurs in patients who are alcohol dependent and who have stopped or reduced their alcohol intake within hours or days of presentation.123 Common symptoms include anxiety, nausea or vomiting, autonomic dysfunction, and insomnia.123 If alcohol withdrawal is not treated or is inadequately treated, 5% of patients will progress to alcohol withdrawal delirium (also known as delirium tremens). Alcohol withdrawal delirium is characterised by hallucinations, delusions, profound confusion and delirium, coarse tremor, and features of clinical instability.456 This is a life threatening feature of severe alcohol withdrawal and generally occurs 48 to 72 hours after the last …

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