Withdrawal syndromes
Alcohol : tremor and anxiety at 6 to 24 h, seizures at 12 to 48 h, delirium tremens at 48 to 96 h. Potentially fatal. Thiamine before glucose, always.. Benzodiazepines : similar to alcohol, later onset, also potentially fatal. Never stop abruptly.. Opioids : intensely uncomfortable but rarely fatal. Mydriasis, yawning, rhinorrhea, cramps, diarrhea, gooseflesh, muscle pain.. Nicotine : irritability, difficulty concentrating, craving. Often mistaken for agitation on the unit. Ask about substance use on admission, including alcohol quantified in real terms.