Compensation for the CNS depressant effects of EtOH occurs in chronic alcoholism. Consequently, rebound CNS hyperactivity may result from falling EtOH levels. Clinical signs of EtOH withdrawal are classified as major or minor (the degree of autonomic hyperactivity and the presence/absence of DTs differentiates these), as well as early (24–48 hrs) or late (> 48 hrs).
Signs/symptoms include tremulousness, hyperreflexia, insomnia, N/V, autonomic hyperactivity (tachycardia, systolic HTN), agitation, myalgias, mild confusion. If Alcohol withdrawal seizures occur, they tend to be early. Perceptual disturbances or frank hallucinosis may also occur early. Hallucinosis consists of visual and/or auditory hallucinations with an otherwise clear sensorium (which distinguishes this from the hallucinations of delirium tremens). DTs can occur 3–4 days after cessation of drinking.
Suppressed by benzodiazepines, resumption of drinking, β-adrenergic antagonists, or α2-agonists.