Alcohol withdrawal

Tremor, sweating, anxiety, agitation, insomnia, seizures after cessation

EmergentReview due

Compare (7)

At a glance

High risk: Yes
Onset: 6 to 24 h
Course: Escalating
Treatable: Yes

Safety snapshot

Watch forSeizuresdelirium tremenssevere autonomic instabilityWernicke risk

Presentation hinge

Timing after last drink plus autonomic overdrive and tremor are classic.

Separates the Substance Withdrawal group. It is not specific to Alcohol withdrawal.

Do now

1Establish the time of the last drink and the usual daily intake, and ask about any previous withdrawal seizure or delirium tremens
2Start structured withdrawal scoring and observations on the local protocol rather than assessing ad hoc
3Give parenteral thiamine before any carbohydrate load, and continue it for the admission
4Send U&E, magnesium, LFT, FBC, glucose and a venous gas, and correct magnesium and potassium
5Escalate for a seizure, a rising score despite treatment, or any feature of delirium tremens or Wernicke encephalopathy

Locally authored, reviewed by PsychSift on 27 September 2026

Clinical review

Rows marked “Whole group”: Applies to the Substance Withdrawal group — not specific to Alcohol withdrawal

Why it fits

Tremor, sweating, anxiety, agitation, insomnia, seizures after cessation

Key features

Must-not-miss

Seizures, delirium tremens, severe autonomic instability, Wernicke risk.

High-risk causes4 causes

Seizures
delirium tremens
severe autonomic instability
Wernicke risk

Bedside question

Applies to the Substance Withdrawal group.

Timing after last drink plus autonomic overdrive and tremor are classic.

Helpful clues

Immediate action

Applies to the Substance Withdrawal group.

CIWA-Ar if suitable, vitals, BGL, electrolytes, seizure and DTs risk, thiamine need Use medical-first, trauma-informed withdrawal pathway Can be fatal and is often under-recognised Stimulant crash is a significant suicide-risk window

Priority steps4 steps

1CIWA-Ar if suitable, vitals, BGL, electrolytes, seizure and DTs risk, thiamine need
2Use medical-first, trauma-informed withdrawal pathway
3Can be fatal and is often under-recognised
4Stimulant crash is a significant suicide-risk window

Investigations

Applies to the Substance Withdrawal group.

Blood glucose, Vitals, oxygen saturation, Urea, electrolytes, creatinine

Core tests3

Blood glucose
Vitals, oxygen saturation
Urea, electrolytes, creatinine

Mimics / overlap

Applies to the Substance Withdrawal group.

None listed

Consider

Do now

1Establish the time of the last drink and the usual daily intake, and ask about any previous withdrawal seizure or delirium tremens
2Start structured withdrawal scoring and observations on the local protocol rather than assessing ad hoc
3Give parenteral thiamine before any carbohydrate load, and continue it for the admission
4Send U&E, magnesium, LFT, FBC, glucose and a venous gas, and correct magnesium and potassium
5Escalate for a seizure, a rising score despite treatment, or any feature of delirium tremens or Wernicke encephalopathy

Locally authored, reviewed by PsychSift on 27 September 2026

First-line tests

Applies to the Substance Withdrawal group — not specific to Alcohol withdrawal

Blood glucose
Vitals, oxygen saturation
Urea, electrolytes, creatinine

Watch for

Seizures
delirium tremens
severe autonomic instability
Wernicke risk

Also consider

Source and review

Review due· Unverified

v10 · exported 2026-07-11

Clinical reference — not validated decision support. Review before use.