**7. Complications and their implications on patient safety**

The most important considerations regarding the safety surrounding treating alcohol use disorder and alcohol withdrawal in the hospital setting are early assessment, identification, and intervention and treatment of associated medical complications. Progression of alcohol withdrawal is preventable and delirium tremens is avoidable all together with proper treatment. As patients progress along the AWS spectrum, they become more prone to increasing risk of morbidity and mortality, including sepsis, aspiration, malnutrition, encephalopathy, falls, dysrhythmias, permanent cognitive impairment, and death. Coexisting psychosocial conditions, such as depression and anxiety, should also be attended to decrease risk of self-harm.

Encephalopathy is of particular concern because it is difficult to distinguish and exclude Wernicke's Encephalopathy in the setting of DT. Wernicke's Encephalopathy is about 80% reversible if treated early with high dose thiamine, and if untreated, can progress to Wernicke-Korsakoff Syndrome, which is only about 20% reversible with high dose thiamine. High dose thiamine regimen should be 500 mg IV TID for three days, followed by 100 mg IV or PO for 4 days, followed by 100 mg PO indefinitely. Clinicians should not be tempted to truncate thiamine regimen with improvement of encephalopathy as the observed improvement may be the result of the treatment and, therefore, the full course is indicated.

Interdisciplinary collaboration is of the utmost importance to incorporate expertise in addiction and withdrawal management. Hospitals should invest in these resources for improved patient outcomes. Consultants in this area generally exist in the fields of Addiction Medicine, Addiction Psychiatry, and Medical Toxicology. Case managers and social workers should also be utilized to counsel patients and assist in coordinating further treatment after discharge.
