THE COURSE OF ALCOHOL-WITHDRAWAL IN A GENERAL-HOSPITAL

We conducted an observational study of 539 episodes of alcohol withdra wal in a general hospital, to determine the natural history, the incid ences of seizures, hallucinations and delirium, and the risk factors f or these events. The reaction began soon after arrival, at a median ti me of 5 h, and resolved at a median time of 22 h. Patients with a bloo d alcohol level of zero were in withdrawal on arrival, and only four p atients had reactions lasting 120 h or longer. Complications were obse rved in 113 patients (21%) during the admission. Seizures occurred on arrival, hallucinations usually in the first 24 h and delirium in the first 48 h. No mortality was associated with alcohol withdrawal itself , but complications did extend length of stay by a median of 4 days, w ith delirium contributing most to the increase. Patients over 70 years of age or admitted with seizures had an increased risk of complicatio n, but the greatest risk was associated with a delay in assessment of > 24 h. We conclude that in general hospitals, the alcohol withdrawal reaction becomes established very early, and detection and monitoring of patients within the first 24 h is the most important element in man agement.