Alcohol withdrawal can be deadly. Knowing the timeline helps you catch problems before they turn into seizures or delirium tremens.
Timeline after the last drink
| Time | What you may see |
|---|---|
| 6 to 24 hours | Tremors, anxiety, sweating, nausea, fast heart rate, trouble sleeping |
| 12 to 48 hours | Withdrawal seizures; some clients have hallucinations |
| 48 to 72 hours | Delirium tremens (DTs): severe confusion, hallucinations, fever, very fast heart rate, high BP. A medical emergency |
CIWA
The CIWA-Ar scale scores symptoms like tremor, sweating, anxiety, agitation, and hallucinations. Higher scores mean more severe withdrawal and guide how much benzodiazepine (like lorazepam or chlordiazepoxide) the client receives.
Nursing care
- Thiamine before glucose. Giving glucose first can trigger Wernicke encephalopathy: confusion, unsteady walking, and eye movement problems.
- Seizure precautions
- A quiet, low-light room with less stimulation
- Fluids and electrolytes, especially magnesium and potassium
- Frequent vital signs and CIWA checks
- Fall precautions
A client admitted 2 days ago is now confused, seeing bugs on the wall, with a heart rate of 128 and a temperature of 38.6 °C. What does the nurse suspect?
Show answer
Delirium tremens. Notify the provider right away, treat per CIWA or orders, keep the client safe, and start seizure precautions.
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Quick answers
When does delirium tremens start?
Usually about 48 to 72 hours after the last drink. It causes severe confusion, hallucinations, fever, and unstable vital signs.
Why give thiamine before glucose in alcohol withdrawal?
Glucose given first can use up the remaining thiamine and trigger Wernicke encephalopathy.
Evidence & Clinical Sources
- ASAM Clinical Practice Guideline on Alcohol Withdrawal Management
- Halter, Varcarolis' Foundations of Psychiatric-Mental Health Nursing, Elsevier
Reviewed against current guidelines and drug labels. Always follow your program, a current drug reference, and facility policy. Our sources policy
For learning only. Lab ranges and policies vary. Always follow your nursing program, a current drug reference, and your facility's policies.