đč Ethanol (EtOH) leads to potentiation of the GABA (neuroinhibitory). Chronic drinkers will develop a downregulation of GABA receptors, leading to a compensatory upregulation in glutamate (neuroexcitatory) to maintain neurotransmitter homeostasis.
đČ Signs and symptoms of acute alcohol withdrawal are attributed to excessive glutamate in the absence of EtOH. These include tachycardia, diaphoresis, hypertension, agitation, irritability, hallucinations, tremors, and seizures amongst others.
The typical onset of withdrawal symptoms are within 48 hours of last drink. Severity of the symptoms are dependent on chronicity of consumption.
Benzodiazepines are first line therapy for alcohol withdrawal given their GABAnergic effects. Chloridazepoxide is the preferred oral agent given the long-acting metabolites and light sedative properties. Lorazepam and diazepam are common agents used IV since they are longer acting. When compared, both agents are as effective and safe.
Phenobarbital has seen fairly recent resurgence in alcohol withdrawal. Based on the mechanism, phenobarbital should only be considered in moderate to severe cases. Not only does phenobarbital provide prolonged Cl- channels opening, it also acts as an NMDA receptor antagonist with a reduction in glutamate.
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