Alcohol Withdrawal Syndrome: Diagnosis, CIWA-Ar Scoring, and Evidence-Based Management
Alcohol Withdrawal Syndrome: An Overlooked Medical Emergency Alcohol Withdrawal Syndrome (AWS) is a common yet frequently under-recognized medical condition encountered in emergency departments, hospital wards, and perioperative settings across the United States. Failure to identify and treat AWS early can result in seizures, delirium tremens, prolonged hospitalization, and increased mortality . AWS occurs after the sudden reduction or cessation of alcohol intake in individuals with chronic dependence. Long-term alcohol exposure leads to downregulation of GABA-mediated inhibition and upregulation of glutamatergic excitation . When alcohol is withdrawn, this imbalance results in autonomic hyperactivity and central nervous system excitability . Clinical Spectrum Symptoms typically begin 6–24 hours after the last drink and may progress through: Tremor, anxiety, diaphoresis Tachycardia and hypertension Hallucinations and agitation Seizures and delirium tremens (DTs) Assessment an...