Alcoholic Hallucinosis or Alcohol Withdrawal Delirium

Alcohol withdrawal delirium (AWD), also called Alcoholic hallucinosis, is the most severe type of alcohol withdrawal. It causes problems that are sudden and severe in a person’s brain and nervous system.

It is estimated that 50 percent of individuals who have alcohol addiction will deal with withdrawal symptoms if they stop drinking suddenly. Of those people who abruptly stop drinking, 3 to 5 percent will suffer AWD symptoms like such as mal seizures and severe confusion.

Causes of alcohol withdrawal delirium

AWD is a condition that only affects people who have a history of acute alcohol use. Heavy drinkers may get this condition if they:

  • Reduce their alcohol use too quickly
  • Suddenly stop drinking
  • Do not eat enough when reducing alcohol use
  • Are sick or have an infection
  • Have a head injury

Excessive drinking irritates and excites the nervous system. If you are a daily drinker, over time, your body becomes dependent on alcohol. When this occurs, your central nervous system can no longer quickly adapt to the absence of alcohol.

Alcohol will impact the brain’s neurotransmitters. These are the chemicals that function as the brain’s messengers to other parts of the brain and the nervous system.

When a person drinks, the alcohol will suppress some of the neurotransmitters in the brain. This is what may cause a person to feel relaxed when they drink.

When the neurotransmitters are not suppressed any longer but are used to working twice as hard to overcome the suppression, they evolve into a state of overexcitement.

Where you stop drinking suddenly, or you significantly reduce the amount of alcohol you consume, it can lead to alcohol withdrawal.

Who are those at risk of alcohol withdrawal delirium

A person is at risk of AWD if they have:

  • A history of alcohol withdrawal
  • Been drinking heavily for a long time
  • Other medical problems in addition to alcoholism
  • A history of AWD
  • A history of seizure disorder or any other form of brain damage

All heavy and long-term drinkers stand a risk of AWD. According to the Centers for Disease Control and Prevention, heavy drinking is defined as eight drinks a week for women and 15 drinks a week for men.

Below are the equivalent of one drink:

  • 1.5 ounces of distilled spirits or liquor, including rum, gin, vodka, and whiskey
  • 8 ounces of malt liquor
  • 5 ounces of wine
  • 12 ounces of beer

The most common form of heavy drinking is binge drinking. For women, binge drinking is defined as four or more drinks in a single sitting. For men, binge drinking is defined as five or more drinks in a single session.

Discuss with your doctor if you are worried about your drinking habits. They are in the best place to recommend programs that can help you stop alcohol consumption.

They can also help you with managing any symptoms of alcohol withdrawal you deal with when you stop consuming alcohol.

What are the symptoms of alcohol withdrawal delirium (AWD)?

The symptoms of AWD usually show up within three days of reducing or stopping alcohol use. However, there are times when they may take a week or longer to appear.

The symptoms of AWD may include:

  • Chest pain
  • Agitation or irritability
  • Anxiety
  • Excitement
  • Confusion
  • Delusions (irrationally believing untrue things)
  • Delirium (an alarming state of mind)
  • Excessive sweating
  • Fatigue
  • Eye and muscle movement problems
  • Fear
  • Fever
  • Increased heart rate or breathing rate
  • Hallucinations (seeing or hearing things that aren’t there)
  • Involuntary muscle contractions
  • Increased startle reflex (an exaggerated reaction to unexpected stimuli)
  • Nightmares
  • Sensitivity to light, sound, or touch
  • Nausea
  • Restlessness
  • Seizures
  • Sudden mood changes
  • Stomach pain

Alcohol withdrawal timeline

Alcohol withdrawal symptoms can begin as soon as two hours after you had your last drink, but it will most likely start between six hours to one day after your last drink.

Withdrawal can easily be broken into four stages with different symptoms.

Stage 1: 6 to 12 hours after a person’s last drink

When it comes to the first stage of alcohol withdrawal, it usually begins 6 to 12 hours after a person’s last drink. The minor withdrawal symptoms associated with this stage can include:

  • Insomnia
  • Nausea
  • Anxiety
  • Loss of appetite
  • Sweating
  • Increased or irregular heart rate
  • Headache

Stage 2: 12 to 24 hours after the last drink

The second stage of alcoholic hallucinosis may happen 12 to 24 hours after the last drink and can continue up to 2 days after the last drink. It may involve the following kinds of hallucinations:

  • Auditory hallucinations or hearing sounds that are not real
  • Tactile hallucinations, such as having a sense of burning, itching, or numbness that isn’t occurring
  • Visual hallucinations, or visualizing images that are not real.
  • It is not common for people who are dealing with alcohol withdrawal to have hallucinations for more than 48 hours after they had their last drink.

Stage 3: 24 to 48 hours after the last drink

At this stage, withdrawal seizures are most experienced typically 24 to 48 hours after a person’s last drink.

Stage 4: 48 to 72 hours after the last drink

AWD at the 4th stage sets in between 48 to 72 hours after a person’s last drink. Most symptoms will typically peak five days after they start, and will gradually decrease about five days to one week after they begin.

How is alcohol withdrawal delirium diagnosed?

Contact your doctor immediately if you’re worried about the symptoms you are dealing with during alcohol withdrawal.

Your doctor will have to review your medical history, inquire about your symptoms, and also conduct a physical examination. Some of the signs your doctor will look for are:

  • Irregular heart rate
  • Hand tremors
  • Dehydration
  • Fever

Your doctor may also carry out a toxicology screen. This is to test how much alcohol is in your system. Toxicology screening is usually done with a urine or blood sample, and can also indicate if there are any other substances are in your system.

If you’re getting inpatient treatment, then your doctor may need to perform toxicology screens more than one time to monitor your alcohol levels.

Some other tests that your doctor may order to evaluate your alcohol dependency or the severity of withdrawal are:

  • Blood magnesium level
  • Blood phosphate level
  • Comprehensive metabolic panel
  • ECG
  • EEG

There are a series of questions that can be used for measuring alcohol withdrawal, and they are contained in the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar). Your doctor may make use of this test to diagnose alcohol withdrawal.

He can also use it to determine how severe your symptoms are. The scale measures these ten symptoms:

  • Anxiety
  • Agitation
  • Auditory disturbances
  • Headache
  • Clouding of the sensorium, or the inability to think clearly
  • Nausea
  • Tactile disturbances
  • Visual disturbances
  • Paroxysmal sweats, or sudden, uncontrollable sweating
  • Tremors
  • Vomiting

The questions your doctor may ask you include:

  • What day is this?
  • Who am I?
  • Does it feel like there is a band around your head?
  • Do you feel sick to your stomach?
  • Do you feel bugs crawling under your skin?
  • How is alcohol withdrawal delirium treated?

There are treatments for AWD, and they may include:

  • Intravenous fluids
  • Anticonvulsants to stop or prevent seizures
  • Sedatives to treat anxiety and calm agitation
  • Antipsychotic medications to stop hallucinations
  • Medication to lessen body aches and fever
  • Treatment for any other alcohol-related conditions
  • Rehabilitation will assist you to stop drinking

AWD can sometimes be fatal. Your doctor may also suggest that you get treatment in a hospital so that your healthcare team can closely monitor your condition and help manage any complications. You may need up to a week to feel better.

Rehabilitation is recommended as a long-term treatment plan that is intended to help with treating alcohol addiction.

Complications of alcohol withdrawal delirium

  • Alcohol-related liver disease
  • Alcoholic cardiomyopathy
  • Alcoholic neuropathy
  • Wernicke-Korsakoff syndrome

To prevent AWD, the best thing to do is take minimal amounts of alcohol or avoid alcohol altogether.

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