UMEM Educational Pearls

Category: Toxicology

Title: ETOH Withdrawal Risk Factors

Keywords: ethanol, withdrawal (PubMed Search)

Posted: 4/21/2011 by Fermin Barrueto, MD (Updated: 5/27/2024)
Click here to contact Fermin Barrueto, MD

The ability to determine whether or not a patient is an alcoholic or will go into alcohol withdrawal syndrome (AWS) is not amenable to a clinical decision rule though many attempts have been made. The strongest predictor that a patient can develop AWS is a positive family history of AWS. Some clinical and biochemical predictors are:

ALT >50 U/L

K <3.6

These two in one study have had an odds ratio of 9.0 and 5.7 respectively though specificity was quite low. Ethanol levels has also found to be contradictory. Being able to predict AWS does not currently seem plausible but the treatment of AWS should and can involve a clinical decision rule like CIWA-Ar which is a scoring system that takes into account N/V, tremor, sweats, anxiety, agitation, hallucinations, headache and sensorium. Take a look at the scoring system that is most validated and utilized for symptom triggered therapy - often considered the most effective treatment for alcohol withdrawal.


Rogers et al. Effect of disulfiram on adrenaergic function. Clin Pharmacol Ther 1979.


1104212257_CIWA-Ar.pdf (10 Kb)