Alcohol withdrawal fever
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Alcohol Withdrawal Fever: Prevalence, Causes, and Complications
Prevalence of Fever During Alcohol Withdrawal
Fever is a common symptom experienced during alcohol withdrawal syndrome (AWS). A study reviewing 110 episodes of alcohol abstinence syndrome found that 65% of cases presented with low-grade fever (37-37.9°C), while 21% exhibited high-grade fever (≥38°C). This indicates that fever is a prevalent issue among individuals undergoing alcohol withdrawal.
Causes of Fever in Alcohol Withdrawal
The causes of fever during alcohol withdrawal are varied. In a significant number of cases, the fever can be attributed to infections. Catheter-associated phlebitis was identified as the cause in 41% of cases, respiratory infections in 16%, and urinary tract infections in 12%. Additionally, patients with low serum albumin levels were more prone to respiratory and urinary tract infections, which could contribute to fever. However, in 40% of the cases, no specific cause for the fever was identified, with these instances more commonly associated with low-grade fever.
Severe Complications: Hypovolemic Shock
Severe diaphoresis and fever during alcohol withdrawal can lead to hypovolemic shock, a serious medical condition. A case report highlighted a patient who experienced hypovolemic shock and acute renal failure due to excessive sweating and fever, despite adequate food intake. This condition was resolved with the infusion of extracellular fluid, underscoring the importance of monitoring fluid intake and managing symptoms aggressively during alcohol withdrawal.
Alcohol Withdrawal in Critically Ill Patients
In critically ill patients, alcohol withdrawal can lead to significant complications, including delirium tremens (DT). The prevalence of AWS in ICU patients varies widely, from less than 1% to 60%, depending on the population studied. Alcohol dependence and a history of withdrawal are major risk factors for AWS in these patients. Despite the high risk, no validated screening tools for AWS exist in the ICU setting, and the benefit of prophylactic measures remains unproven. Early and aggressive symptom-guided medication titration is the only approach associated with improved outcomes.
Conclusion
Fever is a common and significant symptom during alcohol withdrawal, with various underlying causes, including infections and severe diaphoresis leading to hypovolemic shock. Effective management of AWS, particularly in critically ill patients, requires vigilant monitoring and aggressive treatment to mitigate complications. Further research is needed to develop validated screening tools and evidence-based guidelines for the prevention and treatment of AWS in different patient populations.
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