Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol

• Published in: Internal and emergency medicine Vol. 14; no. 1; pp. 143 - 160
• Main Authors: Caputo, Fabio, Agabio, Roberta, Vignoli, Teo, Patussi, Valentino, Fanucchi, Tiziana, Cimarosti, Paolo, Meneguzzi, Cristina, Greco, Giovanni, Rossin, Raffaella, Parisi, Michele, Mioni, Davide, Arico’, Sarino, Palmieri, Vincenzo Ostilio, Zavan, Valeria, Allosio, Pierluigi, Balbinot, Patrizia, Amendola, Maria Francesca, Macciò, Livia, Renzetti, Doda, Scafato, Emanuele, Testino, Gianni
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2019; Springer Nature B.V
• Subjects: Alcohol use; Alcohol withdrawal; Antipsychotics; Ce - Original; Clomethiazole; Convulsions; Internal Medicine; Intoxication; Medical diagnosis; Medicine; Medicine & Public Health; Patients; Phenobarbital; Propofol; Sodium; Pharmacological treatment; Alcohol withdrawal syndrome; Acute alcohol intoxication
• ISSN: 1828-0447; 1970-9366; 1970-9366
• DOI: 10.1007/s11739-018-1933-8

The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3–5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the “gold standard” for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS.