Withdrawal Syndromes Questions & Answers

Updated: Aug 15, 2018
  • Author: Nathanael J McKeown, DO; Chief Editor: David Vearrier, MD, MPH  more...
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Questions & Answers

Overview

What is withdrawal syndrome?

What are the signs and symptoms of withdrawal syndrome?

What are the symptoms of sedative-hypnotic withdrawal syndrome?

What are the symptoms of opioid withdrawal syndrome?

What are the symptoms of stimulant withdrawal syndrome?

Which lab tests may be performed in the evaluation of withdrawal syndrome?

What is the treatment options for alcohol withdrawal syndrome?

How is sedative-hypnotic withdrawal syndrome treated?

What are the treatment options for gamma-hydroxybutyrate (GHB) withdrawal syndrome?

What are the treatment options for opioid withdrawal syndrome?

How is stimulant-withdrawal syndrome treated?

Which substances produce withdrawal syndrome?

What is the pathophysiology of withdrawal syndrome?

What is the role of tolerance in the pathophysiology of withdrawal syndrome?

What is pathophysiology of ethanol withdrawal syndrome?

What is the pathophysiology of withdrawal syndrome from gamma-aminobutyric acid (GABA) receptor agonists?

What is the pathophysiology of opioid withdrawal syndrome?

What is the prevalence of withdrawal syndrome in the US?

What is the mortality and morbidity of alcohol withdrawal syndrome?

What is the mortality and morbidity of opioid withdrawal syndrome?

How does the prevalence of withdrawal syndromes vary by sex?

How does the prevalence of withdrawal syndromes vary by age?

Presentation

What should be the focus of history in suspected withdrawal syndrome?

When should a history of illicit drug and alcohol abuse be obtained?

Which clinical history is characteristic of alcohol withdrawal syndrome?

What are the signs and symptoms of mild alcohol withdrawal syndrome?

What are the signs and symptoms of moderate alcohol withdrawal syndrome?

What are the signs and symptoms of severe alcohol withdrawal syndrome?

Which factors increase the risk of severe alcohol withdrawal syndrome?

What are the signs and symptoms of alcoholic hallucinosis in withdrawal syndrome?

What are the features of alcohol withdrawal seizures?

What are the features of delirium tremens (DT)?

Which substances might be ingested by patients to blunt the effects of alcohol withdrawal syndrome?

What are the features of sedative-hypnotic withdrawal syndrome?

What are the features of gamma-hydroxybutyrate (GHB) withdrawal syndrome?

What is the challenge in the diagnosis of opioid withdrawal syndrome?

What are the signs and symptoms of opioid withdrawal syndrome?

How does the half-life of opioids affect the onset and duration of withdrawal syndrome?

Which disorders should be included in the differential diagnoses of withdrawal syndrome in patients with a history of long-term IV drug use?

What are the features of stimulant withdrawal syndrome?

What is the focus of physical exam for withdrawal syndrome?

Which vital signs are characteristic of withdrawal syndrome?

Which head and neck exam findings are characteristic of withdrawal syndrome?

Which chest exam findings are characteristic of alcohol withdrawal syndrome?

Which chest exam findings are characteristic of opiate withdrawal syndrome?

Which cardiac findings are characteristic of withdrawal syndrome?

Which abdominal exam findings are characteristic of withdrawal syndrome?

Which findings of the limbs and joints are significant in withdrawal syndrome?

Which neurologic exam findings suggest withdrawal syndrome?

What are dermatologic findings suggestive of withdrawal syndrome?

DDX

What are the differential diagnoses for Withdrawal Syndromes?

Workup

What is the role of lab studies in the workup of withdrawal syndrome?

Which CBC count findings suggest withdrawal syndrome?

What is the role of a comprehensive metabolic panel in the workup of withdrawal syndrome?

What is the role of urinalysis in the workup of withdrawal syndrome?

What is the role of cardiac markers in the workup of withdrawal syndrome?

What is the role of prothrombin time (PT) testing in the workup of withdrawal syndrome?

What is the role of toxicology screening in the workup of withdrawal syndrome?

What is the role of chest radiography in the workup of withdrawal syndrome?

What is the role of CT scanning in the workup of withdrawal syndrome?

What is the role of spinal MRI in the workup of withdrawal syndrome?

What is the role of electrocardiography in the workup of withdrawal syndrome?

What is the role of lumbar puncture and blood cultures in the workup of withdrawal syndrome?

Treatment

What is included in prehospital management of alcohol withdrawal syndrome?

How should seizures be initially managed in withdrawal syndrome?

When are sedatives indicated for prehospital management of alcohol withdrawal syndrome?

What should be the focus of initial emergency department (ED) care for withdrawal syndrome?

What are the treatment goals for ethanol or sedative-hypnotic withdrawal syndrome?

How is withdrawal syndrome managed in the emergency department (ED)?

What is the initial management of moderate or severe alcohol withdrawal syndrome and delirium tremens (DT)?

What are the emergency department (ED) treatment options for different types of withdrawal syndromes?

What are the American Academy of Pediatrics treatment guidelines for opioid dependence and withdrawal in children?

What is included in inpatient care for opioid withdrawal syndrome?

What is the role of methadone in the treatment of withdrawal syndromes?

What is the role of buprenorphine in the treatment of withdrawal syndromes?

Which medications are used in the treatment of alcohol withdrawal syndrome?

What is the role of benzodiazepines in the treatment of alcohol withdrawal syndrome?

What are the benefits of IV administration of drugs in the treatment of alcohol withdrawal syndrome?

What is basis for selection of a specific benzodiazepine for the treatment of alcohol withdrawal syndrome?

How is lorazepam administered in the treatment of alcohol withdrawal syndrome?

How is diazepam administered in the treatment of alcohol withdrawal syndrome?

What are the possible adverse effects of short-acting benzodiazepines for the treatment of alcohol withdrawal syndrome?

How are benzodiazepines administered in the treatment of alcohol withdrawal syndrome?

What second-line treatment options for alcohol withdrawal syndrome?

What is the role of dexmedetomidine in the treatment of alcohol withdrawal syndrome?

What is the role of neuroleptics in the treatment of alcohol withdrawal syndrome?

What is the role of ketamine in the treatment of alcohol withdrawal syndrome?

What is the role of gabapentin and pregabalin in the treatment of alcohol withdrawal syndrome?

Medications

What is the role of medications in the treatment of withdrawal syndromes?

Which medication regimens are used in the treatment of withdrawal syndromes?

Which medications in the drug class Anesthetics are used in the treatment of Withdrawal Syndromes?

Which medications in the drug class Electrolyte Replacement are used in the treatment of Withdrawal Syndromes?

Which medications in the drug class Pharmacologic antidotes are used in the treatment of Withdrawal Syndromes?

Which medications in the drug class Barbiturate are used in the treatment of Withdrawal Syndromes?

Which medications in the drug class Vitamins are used in the treatment of Withdrawal Syndromes?

Which medications in the drug class Cardiovascular agents are used in the treatment of Withdrawal Syndromes?

Which medications in the drug class Benzodiazepines are used in the treatment of Withdrawal Syndromes?

Follow-up

What is included in outpatient management of withdrawal syndrome?

What is the role of addiction treatment programs in the management of withdrawal syndrome?

What are treatment considerations for inpatient care of withdrawal syndromes?

When is transfer indicated for the treatment of withdrawal syndrome?

In which withdrawal syndrome are complications most common?

What are possible metabolic complications of alcohol withdrawal syndrome?

What are possible cardiac complications of alcohol withdrawal syndrome?

What are possible GI complications of alcohol withdrawal syndrome?

What are possible infectious complications of alcohol withdrawal syndrome?

What are possible neurologic complications of alcohol withdrawal syndrome?