ZyraDoc #41 - September 11, 2026

A 45-year-old male with a long-standing history of heavy daily alcohol consumption is admitted to the surgical ward following an emergency appendectomy 24 hours ago.

He becomes increasingly anxious, agitated, and diaphoretic, with physical examination revealing a coarse postural hand tremor, tachycardia (heart rate 116 beats/min), and elevated blood pressure (158/96 mmHg).

His Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) score is calculated at 18, indicating moderate-to-severe alcohol withdrawal and a high risk of progression to delirium tremens.

Case Summary

Clinical Focus:

The diagnosis is Alcohol Withdrawal Syndrome (AWS).

Aetiology/Cause:

Abrupt cessation or significant reduction of prolonged, heavy alcohol intake.
Chronic alcohol exposure causes downregulation of inhibitory GABA-A receptors and upregulation of excitatory NMDA glutamate receptors.
Sudden alcohol withdrawal removes GABAergic inhibition while leaving uninhibited NMDA receptor stimulation, resulting in central nervous system hyperarousal and autonomic hyperactivity.

Clinical Features:

Autonomic instability including tachycardia, systemic hypertension, profuse diaphoresis, hyperthermia, and tachypnea.
Neuromuscular and psychological distress including coarse hand tremors, severe anxiety, agitation, insomnia, and hyperreflexia.
Gastrointestinal symptoms such as persistent nausea, anorexia, and vomiting.
Perceptual disturbances ranging from transient tactile, auditory, or visual halluclinosis to florid delirium.

Diagnosis and Investigations:

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