5
C. Differential Diagnosis
Î Recommendation I.8: As part of differential diagnosis, assess
the patient's signs, symptoms, and history. Rule out other serious
illnesses that can mimic the signs and symptoms of alcohol
withdrawal. Determine if patients take medications that can mask the
signs and symptoms of alcohol withdrawal.
Î Recommendation I.9: Do not rule in or rule out a co-occurring disease,
co-occurring mental health disorder, co-occurring substance use
disorder, or simultaneous withdrawal from other substances even in
the presence of alcohol withdrawal.
Î Recommendation I.10: Conduct a neurological exam in patients
presenting with a seizure to determine etiology. A seizure should
only be attributed to alcohol withdrawal if there was a recent
cessation of (or reduction in) a patient's alcohol consumption. For
patients experiencing new onset seizures or for patients with a known
history of alcohol withdrawal seizures showing a new pattern, an
electroencephalogram and/or neuroimaging is recommended. For
patients with a known history of withdrawal seizure who present with
a seizure that can be attributed to alcohol withdrawal, additional
neurological testing and a neurology consult may not be necessary.
This includes if the seizure was generalized and without focal
elements, if a careful neurological examination reveals no evidence
of focal deficits, and if there is no suspicion of meningitis or other
etiology.
Î Recommendation I.11: For patients presenting with delirium, conduct
a detailed neurological and medical examination with appropriate
testing to rule out other common causes of delirium regardless of
the apparent etiology. Attempt to distinguish between hallucinations
associated with alcohol withdrawal delirium and alcohol hallucinosis/
alcohol-induced psychotic disorder.
