What are the key clinical features to assess in a patient presenting with suspected alcohol withdrawal syndrome?

When assessing a patient with suspected alcohol withdrawal syndrome, key clinical features to evaluate include:

• Physical symptoms: tremor, sweating, tachycardia, hypertension, nausea, vomiting, headache, and sensory disturbances such as hallucinations.
• Neurological signs: agitation, anxiety, seizures, and delirium tremens (characterized by confusion, hallucinations, and autonomic instability).
• Severity of withdrawal symptoms: use of a validated tool such as the Clinical Institute Withdrawal Assessment – Alcohol, revised (CIWA–Ar) scale is recommended to quantify severity and guide management.
• Risk factors for complicated withdrawal: history of withdrawal seizures or delirium tremens, high daily alcohol intake, comorbid physical or psychiatric conditions, malnutrition, and social support availability.
• Vital signs and general physical examination: to identify signs of autonomic hyperactivity and complications such as dehydration or infection.
• Psychosocial assessment: including evaluation of alcohol dependence severity, social circumstances, and risk to self or others.

Immediate assessment by a healthcare professional skilled in alcohol withdrawal management is essential, especially for those at high risk of severe withdrawal complications.

Use of formal assessment tools and adherence to local protocols for monitoring are advised to ensure safe and effective care.

These assessments inform decisions about the need for hospital admission and pharmacological treatment.

References: NICE CG100,NICE CG115