ACMT Recommends Participation of a Medical Toxicologist in Treatment of Alcohol Withdrawal

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The American College of Medical Toxicology has released a position statement recommending the participation of a medical toxicologist in the medical care of patients with alcohol withdrawal syndrome.

American College of Medical Toxicology

Medical toxicologists have education, training, and clinical experience in the diagnosis and management of alcohol withdrawal and other withdrawal syndromes.

Alcohol withdrawal is a common and potentially life-threatening condition that is encountered daily by physicians in a variety of healthcare settings. The management of a patient with alcohol withdrawal syndrome may vary depending on the individual patient’s clinical findings, the presence of acute or chronic co-existing medical, surgical, or psychiatric illness, and use of prescribed medications or other recreational substances. The large variation in symptoms and in the severity of the syndrome contributes to difficulties in managing patients with this condition. Medical toxicologists have education, training, and clinical experience in the diagnosis and management of alcohol withdrawal and other withdrawal syndromes. Thus, early involvement of a medical toxicologist may be of significant benefit in the care of patients with alcohol withdrawal. The American College of Medical Toxicology has released a position statement recommending participation of a medical toxicologist in the direct or indirect care of patients with suspected or confirmed alcohol withdrawal.

All persons who drink alcohol on a daily or near-daily basis are at risk for development of alcohol withdrawal syndrome following a sudden decrease or cessation of alcohol intake. Patients may voluntarily stop drinking alcohol due to lack of funds or a desire to become sober, or they may stop drinking if alcohol becomes unavailable for a variety of reasons, including hospitalization or incarceration. Often patients are hospitalized for illness or surgery unrelated to alcohol use and unexpectedly develop alcohol withdrawal syndrome. Alcohol withdrawal syndrome itself is also a common diagnosis leading to hospitalization.

Data reported to the ToxIC registry, to be published in the December issue of the Journal of Medical Toxicology, reveals alcohol abuse and withdrawal to be a common problem encountered by medical toxicologists in hospital settings. Alcohol withdrawal symptoms may range from simple anxiety and tremulousness to disturbing hallucinations or seizures. The most dangerous constellation of symptoms is known as delirium tremens. Often referred to simply as ‘DTs’, delirium tremens is characterized by agitation and confusion, and may be accompanied by dangerously elevated blood pressure, heart rate, and body temperature. Failure to recognize and rapidly treat mild or moderate alcohol withdrawal may result in escalation to delirium tremens, and result in irreversible central nervous system damage, other organ systems injury, or persistent psychosis.

While the mortality of alcohol withdrawal has decreased with improvements in intensive care, a significant minority of these patients will die or experience prolonged or permanent illness either from the effects of withdrawal itself or from its complications. The best way to avoid such complications is to achieve rapid control of the patient’s abnormal clinical effects. Medical toxicologists are specially trained in the management of this syndrome. The ACMT maintains a list of medical toxicology admitting and consulting services on its website.

The American College of Medical Toxicology (ACMT) is a professional, nonprofit association of physicians with recognized expertise in medical toxicology. The College is dedicated to advancing the science and practice of medical toxicology.

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