A client going through alcohol withdrawal is assessed at 24 hours since last drink. The nurse notes confusion, tremors, tachycardia, and diaphoresis. What is the PRIORITY concern?

ALCOHOL WITHDRAWAL SYNDROME is one of the FEW substance withdrawals that can be FATAL without treatment. Unlike opioid withdrawal (unpleasant but not life-threatening for most), alcohol and benzodiazepine withdrawal carry risk of life-threatening seizures and delirium.

Timeline of alcohol withdrawal: 6-24 HOURS: tremulousness, anxiety, diaphoresis, nausea, tachycardia, hypertension; 24-48 HOURS: WITHDRAWAL SEIZURES ('rum fits') — generalized tonic-clonic seizures; can occur without warning; 48-72 HOURS: DELIRIUM TREMENS (DTs) — severe confusion/delirium, hallucinations (often visual — seeing insects or animals), severe autonomic instability (hyperthermia, hypertension, tachycardia, diaphoresis), agitation; mortality rate of untreated DTs is 5-15%; treated mortality <1%.

Assessment tool: Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) — standard tool to quantify withdrawal severity and guide treatment; score 10-19 = moderate, score ≥20 = severe.

Treatment: BENZODIAZEPINES are first-line — lorazepam (Ativan), chlordiazepoxide (Librium), diazepam (Valium) per CIWA score or scheduled; THIAMINE (Vitamin B1) — must be given BEFORE glucose to prevent Wernicke's encephalopathy; IV FLUIDS — hydration; SEIZURE PRECAUTIONS; close monitoring.

Nursing actions: notify RN immediately; obtain CIWA score; vital signs frequently (Q1-4h per severity); initiate seizure precautions (padded side rails, suction at bedside, O2 available); administer ordered medications; document assessment; quiet, low-stimulation environment.