Alcohol withdrawal syndrome (AWS) presents a significant problem among new admissions to the intensive care unit. In patients with a history of alcohol abuse, AWS manifests itself with symptoms of autonomic hyperactivity, tremors, hallucinations, agitation, anxiety, and seizures. Progression of AWS, called delirium tremens (DT), is associated with increased mortality. Traditionally, AWS is treated with benzodiazepines which have a well-established record for reducing symptoms of withdrawal and provide adequate control of both seizures and DT. However, the side-effects of benzodiazepines have prompted the introduction of alternative agents. Anticonvulsants and gamma-hydroxybutyrate do suppress symptoms of AWS, but their effectiveness in the prevention of seizures and DT is doubtful. Ethanol results in less sedation than benzodiazepines, although the evidence for its role in AWS remains limited. Alpha-2 agonists are potent against symptoms of noradrenergic overdrive and are suitable as adjuvants to benzodiazepines. Antipsychotics have no demonstrable effectiveness in AWS and may even be harmful.
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