alcohol withdrawal syndrome alcohol withdrawal syndrome alcohol withdrawal syndrome (aws) is a set of symptoms that can occur following a reduction in alcohol use after a period of excessive use. symptoms typically include anxiety, shakiness, sweating, vomiting, fast heart rate, and a mild fever. more severe symptoms may include seizures, and delirium tremens (dts) which can be fatal in untreated patients. symptoms typically begin around six hours following the last drink, are worst at 24 to 72 hours, and improve by seven days. alcohol withdrawal syndromeethanolspecialtytoxicology, addiction medicine, intensive care medicine, psychiatrysymptomsanxiety, shakiness, sweating, vomiting, fast heart rate, mild feverusual onsetsix hours following the last drinkdurationup to a weekcausesreduction or cessation of alcohol intake after a period of excessive usediagnostic methodclinical institute withdrawal assessment for alcohol (ciwa-ar)treatmentbenzodiazepines, thiaminefrequency~50% of people with alcoholism upon reducing use alcohol withdrawal may occur in those who are alcohol dependent. this may occur following a planned or unplanned decrease in alcohol intake. the underlying mechanism involves a decreased responsiveness of gaba receptors in the brain. the withdrawal process is typically followed using the clinical institute withdrawal assessment for alcohol scale (ciwa-ar). the typical treatment of alcohol withdrawal is with benzodiazepines such as chlordiazepoxide or diazepam. often the amounts given are based on a person's symptoms. thiamine is recommended routinely. electrolyte problems and low blood sugar should also be treated. early treatment improves outcomes. in the western world about 15% of people have problems with alcoholism at some point in time. alcohol depresses the central nervous system, slowing cerebral messaging and altering the way signals are sent and received. progressively larger amounts of alcohol are needed to achieve the same physical and emotional results. the drinker eventually must consume alcohol just to avoid the physical cravings and withdrawal symptoms. about half of people with alcoholism will develop withdrawal symptoms upon reducing their use, with four percent developing severe symptoms. among those with severe symptoms up to 15% die. symptoms of alcohol withdrawal have been described at least as early as 400 bc by hippocrates. it is not believed to have become a widespread problem until the 1700s. signs and symptoms signs and symptoms of alcohol withdrawal occur primarily in the central nervous system. the severity of withdrawal can vary from mild symptoms such as insomnia, trembling, and anxiety to severe and life-threatening symptoms such as alcoholic hallucinosis, delirium tremens, and autonomic instability. withdrawal usually begins 6 to 24 hours after the last drink. it can last for up to one week. to be classified as alcohol withdrawal syndrome, patients must exhibit at least two of the following symptoms: increased hand tremor, insomnia, nausea or vomiting, transient hallucinations (auditory, visual or tactile), psychomotor agitation, anxiety, generalized tonic–clonic seizures, and autonomic instability. the severity of symptoms is dictated by a number of factors, the most important of which are degree of alcohol intake, length of time the individual has been using alcohol, and previous history of alcohol withdrawal. symptoms are also grouped together and classified: alcohol hallucinosis: patients have transient visual, auditory, or tactile hallucinations, but are otherwise clear. withdrawal seizures: seizures occur within 48 hours of alcohol cessations and occur either as a single generalized tonic-clonic seizure or as a brief episode of multiple seizures. delirium tremens: hyperadrenergic state, disorientation, tremors, diaphoresis, impaired attention/consciousness, and visual and auditory hallucinations. progression acute confusional state caused by alcohol withdrawal, also known as delirium tremens six to 12 hours after the ingestion of the last drink, withdrawal symptoms such as shaking, headache, sweating, anxiety, nausea or vomiting may occur. twelve to 24 hours after cessation, the condition may progress to such major symptoms as confusion, hallucinations (with awareness of reality), while less severe symptoms may persist and develop including tremor, agitation, hyperactivity and insomnia. at 12 to 48 hours following the last ethanol ingestion, the possibility of generalized tonic–clonic seizures should be anticipated, occurring in 3-5% of cases. meanwhile, none of the earlier withdrawal symptoms will typically have abated. seizures carry the risk of major complications and death for the alcoholic. although the person's condition usually begins to improve after 48 hours, withdrawal symptoms sometimes continue to increase in severity and advance to the most severe stage of withdrawal, delirium tremens. this occurs in 5 to 20% of patients experiencing detoxification and one third of untreated cases, which is characterized by hallucinations that are indistinguishable from reality, severe confusion, seizures, high blood pressure, and fever that can persist anywhere from 4 to 12 days. protracted withdrawal