[Ambulatory management of alcohol withdrawal syndrome]

The alcohol withdrawal syndrome occurs in the hours or days after the cessation of alcohol drinking in an alcohol dependent patient. The alcohol withdrawal syndrome is produced by the emergence of the biological mechanism of neurological tolerance to ethanol. The clinical manifestations of the alcohol withdrawal syndrome are due to the hyperexcitability of the central nervous system: agitation, excitability, tremor, convulsions, status epilepticus, delirium, sympathetic hyperactivity. Usually benign, the alcohol withdrawal syndrome is frequently manageable on an ambulatory basis, as long as no clinical counter-indication is present such as a serious previous alcohol withdrawal syndrome, previous withdrawal convulsions, a significant medical or psychiatric comorbidity, a high level of alcohol consumption, a pregnancy, or the lack of an effective familial or social support. The ambulatory management of the alcohol withdrawal syndrome requires frequently the use of a sedative drug. Benzodiazepines used orally for a duration of 3 to 5 days are actually considered a first choice. Inability to work and drive is frequently present for several days.