Alcohol Withdrawal Syndrome in Neurocritical Care Unit: Assessment and Treatment Challenges

Salia Farrokh, Christina Roels, Kent A. Owusu, Sarah E. Nelson, Aaron M. Cook

Research output: Contribution to journalReview articlepeer-review

Abstract

Alcohol withdrawal syndrome (AWS) can range from mild jittery movements, nausea, sweating to more severe symptoms such as seizure and death. Severe AWS can worsen cognitive function, increase hospital length of stay, and in-hospital mortality and morbidity. Due to a lack of reliable history of present illness in many patients with neurological injury as well as similarities in clinical presentation of AWS and some commonly encountered neurological syndromes, the true incidence of AWS in neurocritical care patients remains unknown. This review discusses challenges in the assessment and treatment of AWS in patients with neurological injury, including the utility of different scoring systems such as the Clinical Institute Withdrawal Assessment and the Minnesota Detoxification Scale as well as the reliability of admission alcohol levels in predicting AWS. Treatment strategies such as symptom-based versus fixed dose benzodiazepine therapy and alternative agents such as baclofen, carbamazepine, dexmedetomidine, gabapentin, phenobarbital, ketamine, propofol, and valproic acid are also discussed. Finally, a treatment algorithm considering the neurocritical care patient is proposed to help guide therapy in this setting.

Original languageEnglish (US)
Pages (from-to)593-607
Number of pages15
JournalNeurocritical care
Volume34
Issue number2
DOIs
StatePublished - Apr 2021

Keywords

  • Alcohol
  • Delirium tremens
  • Neurocritical care
  • Seizure
  • Withdrawal

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

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