Monitoring During Alcohol Withdrawal

All patients in alcohol withdrawal, or who are considered at risk of alcohol withdrawal, should be monitored regularly for: 

      • Blood or breath alcohol level. Breathalyser devices are widely used in withdrawal units to confirm diagnosis of alcohol use, to identify evolving withdrawal risk and safety to use benzodiazepines. Generally, benzodiazepine dosing is not commenced until the blood alcohol concentration (BAC) falls below 0.05% (approximately 10 mmol/L). 

      • Physical signs. This includes level of hydration, pulse rate, blood pressure, temperature, mental state and level of consciousness (especially if medicated). 

      • Severity of alcohol withdrawal. It is usually beneficial to use an alcohol withdrawal rating scale to assess the severity of withdrawal, to guide treatment, and to help clinicians communicate more objectively about the severity and management of alcohol withdrawal. Alcohol withdrawal scales are described below; see Appendix for the instruments. 

      • General progress during withdrawal episode. This includes ongoing level of motivation, alcohol and other drug use during ambulatory withdrawal (breathalyser readings and/or urine drug screens may be clinically indicated), response to any medication(s), and patient concerns or difficulties.