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Custody Operations Informational Bulletins / 2024 Informational Bulletins

2024-03 Recognizing Signs of Alcohol Withdrawal Syndrome


2024-02 Watch Commander Interviews
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                                                                                                                                                            Bulletin #2024-03

RECOGNIZING SIGNS OF ALCOHOL WITHDRAWAL SYNDROME

INTRODUCTION

The purpose of this informational bulletin is to provide all personnel assigned to the Custody Services Divisions valuable information to assist in recognizing patients with acute alcohol withdrawal syndrome to prevent delirium tremens, seizure, and other life-threatening health consequences related to alcohol withdrawal.

If custody personnel detect or observe an inmate with any sign of medical distress or any type of withdrawal symptom, personnel should notify and/or summon medical staff immediately, in accordance with Custody Division Manual (CDM) section 5-03/060.00, “Response to Inmate Medical Emergencies.” If not properly treated, alcohol withdrawal may be fatal.

WHAT IS ALCOHOL WITHDRAWAL SYNDROME

  1. Alcohol Withdrawal is a complication of alcohol use disorder. It is a syndrome of central nervous system hyperactivity, manifested by physical and psychological signs and symptoms that can occur when an individual reduces or stops alcohol consumption after long periods of use. Symptoms can develop within a few hours of decreasing or discontinuing use, and symptoms peak within 24–36 hours. Symptoms may range from mild to severe. Patients may exhibit symptoms prior to their blood alcohol level reaching zero. In many alcoholics, the severity of withdrawal symptoms increases after repeated withdrawal episodes. Uncomplicated alcohol withdrawal is completed within five days.
  2. Mild Withdrawal is characterized by nausea, vomiting, mild agitation or irritability, anxiety, restlessness, mild tremor (involuntary shaking of the hands and/or tongue twitching), insomnia, and craving of alcohol. Vital signs may reveal tachycardia (fast heart rate) and/or hypertension (elevated blood pressure). Mild withdrawal may progress to more severe withdrawal or may resolve in 1-2 days.
  3. Alcoholic Hallucinosis refers to hallucinations that develop within 12 to 24 hours after the last drink. They typically resolve within 24 to 48 hours. The hallucinations are usually visual, although auditory and tactile phenomena may also occur. In contrast to delirium tremens (DTs), which usually begins 48 to 72 hours after the last drink, vital signs are normal and alcoholic hallucinosis is not associated with generalized confusion or disorientation.
  4. Alcohol Withdrawal-Related Seizures are typically brief, generalized tonic-clonic seizures that occur 6 to 48 hours after the last drink. Seizures occur in approximately 10-30% of patients with alcohol withdrawal, and 60% of patients with alcohol withdrawal-related seizures will have multiple seizures. If not treated, withdrawal seizures progress to DTs in about one-third of patients.
  5. Alcohol-Related Psychosis is a secondary psychosis that manifests as prominent hallucinations and delusions. Psychosis can occur during phases of acute intoxication or withdrawal, with or without delirium tremens.
  6. Delirium Tremens (DTs) is the most severe form of alcohol withdrawal manifested by altered mental status (global confusion), agitation, and sympathetic overdrive (autonomic hyperactivity, which may include fever, elevated heart rate, elevated blood pressure, and sweating), which can progress to cardiovascular collapse. DTs is a medical emergency with a high mortality rate of approximately 20%, making early recognition and treatment essential. DTs requires transfer to the emergency department for appropriate management. With treatment, the mortality rate of DTs is 1-4%.

HOW TO RECOGNIZE ALCOHOL WITHDRAWAL

  • Early signs and symptoms of alcohol withdrawal:
    • Nausea/Vomiting
    • Anxiety/Restlessness
    • Irritability
    • Insomnia
    • Tremor (involuntary shaking of the hands, can also check tongue for twitching)
    • Sweating (can range from mild facial redness to drenching in sweat)
  • More serious complications can occur, including:
    • Withdrawal seizures within 6 to 48 hours of the last drink
    • Alcoholic Hallucinosis or psychosis within 24 to 48 hours of the last drink
    • Auditory, tactile (bugs crawling on skin), or visual hallucinations
    • Agitation
  • Delirium tremens begins 48 to 72 hours after the last drink
    • Altered mental status (global confusion)
    • Hallucinations – visual, auditory, and/or tactile
    • Increased heart rate
    • Increased blood pressure
    • Fever
    • Agitation
    • Sweating

HOW TO HELP IF YOU SUSPECT ALCOHOL WITHDRAWAL SYNDROME

  • Notify medical personnel (nurse or provider) so that the appropriate treatment and management plan can be initiated.
  • If a patient is confused, agitated, and/or acting oddly (shadow boxing, pacing, yelling and banging against wall) notify medical personnel immediately.
  • Report worsening conditions (i.e., sudden chest pain, trouble breathing, fainting spells, seizures, continuous vomiting or vomiting blood, confusion, hallucinations, extreme agitation, and shaking that does not get better with medications).

Any question concerning the contents of this bulletin can be directed to Custody Support Services Bureau [REDACTED TEXT].