Always consider withdrawal in your undifferentiated agitated delirium patients!
The pathophysiology of AWS (alcohol withdrawal syndrome) is complicated, but simply stated involves down regulation of GABA receptors with Up regulation of NMDA receptors. This excess neuroexcitation and decreased inhibition is what leads to the clinical symptoms patients with AWS demonstrate.
AWS symptoms can begin as early as 6 hours after a patients last drink.
Benzodiazepines are still the 1st line therapy for alcohol withdrawal. Benzodiazepines are best administered in a symptom triggered fashion in rapid escalating doses with frequent reevaluation of the patient. (example: Diazepam 10 mg, 20 mg, 50 mg, 100 mg; every 15 mins until symptoms improved.)
No study or review has demonstrated a clear winner in superiority when it comes to benzodiazepines.
Adjunctive therapies (i.e.Barbiturates, Propofol, Dexmedetomidine) can be useful in severe AWS or Benzodiazepines resistant cases