• Heavy habitual drinking combined with poor nutrition

Clinical features

Features of malnutrition

  • Weight loss, dry scaly skin
  • Brittle discolored hair, pale mucous membranes

Cerebral damage

  • Memory loss, hallucinations, tremors

Liver disease

  • Poor appetite
  • Fluid in the abdomen (ascites) as a result of cirrhosis


  • Mild: 12-48 hours after the last drink, with anxiety, agitation, insomnia, tremors, palpitation, sweating. If not progressing it may resolve over 24-48 hours
  • Severe: seizures, hallucinations (from 12 to 48 hours after
    the last drink)
  • Very severe: delirium tremens characterized by hallucinations, disorientation, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis In the absence of complications, symptoms of delirium tremens typically
    persist for up to seven days

Wernicke encephalopathy

  • Due to thiamine deficiency. Common in chronic alcohol abuse
  • Characterized by acute mental confusion, ataxia (unstable gait) and nystagmus/ophthalmoplegia (abnormal eye movements)


Withdrawal syndrome
  • Supportive care (IV fluids, nutrition)
  • Check and correct hypoglycaemia with Dextrose 50% 20-50 ml IV
    • Give it via NGT or rectal if IV not available
    • Maintain infusion of Dextrose until patient wakes up and can eat
  • Diazepam 5-10 mg every 10 minutes until appropriate sedation is achieved
    • Very high doses may be required
    • Monitor respiration
  • If not responsing, consider phenobarbital 100- 200 mg slow IV but it has a risk of respiratory depression and hypotension
  • Thiamine IV 100 mg in 1 L of Dextrose 5%
  • If delirium or hallucinations persist in spite of treatment, consider haloperidol 2.5-5 mg up to 3 times a day
If Wernicke encephalopathy
  • Thiamine 100 mg IV or IM every 8 hours for 3-5 days


  • See general management of alcohol use disorders