Which clinical feature is characteristic of early alcohol withdrawal (6–24 hours post-cessation) and distinguishes it from late withdrawal complications?

## Timeline and Staging of Alcohol Withdrawal ### Early Withdrawal (6–24 Hours) **Key Point:** Early withdrawal is characterized by **autonomic hyperactivity** — tremor, tachycardia, hypertension, diaphoresis, anxiety — WITHOUT altered mental status, hallucinations, or seizures. ### Clinical Features by Stage | Stage | Timing | Key Features | Mortality Risk | |-------|--------|--------------|----------------| | **Early withdrawal** | 6–24 hrs | Tremor, autonomic signs, anxiety | Low | | **Hallucinosis** | 12–48 hrs | Visual/auditory hallucinations, **clear sensorium** | Low | | **Withdrawal seizures** | 6–48 hrs | Generalized tonic-clonic, brief, often multiple | Moderate | | **Delirium tremens** | 48–96 hrs | Disorientation, hallucinations, severe autonomic instability | **High (5–15%)** | ### Distinguishing Early Withdrawal **High-Yield:** Early withdrawal is **purely autonomic** — the patient is alert and oriented. Altered mental status or hallucinations indicate progression to hallucinosis or delirium tremens, not early withdrawal. **Mnemonic:** **WATCH** for early withdrawal signs: - **W**idened pupils - **A**nxiety, agitation - **T**remor - **C**ardiac tachycardia, hypertension - **H**yperreflexia ### Clinical Pearl Early withdrawal is highly treatable with benzodiazepines and supportive care; mortality is rare. Progression to delirium tremens (especially if untreated) carries 5–15% mortality due to cardiac arrhythmias, seizures, and aspiration.