Outpatient alcohol withdrawal

Laboratory tests

• FBC
• PT
• AST
• ALT
• GGT
• Fib-4 calculation (from age, AST, ALT and platelets)
• Serum bilirubin
• Serum albumin
• Serum creatinine
• Serum electrolytes
• Lipid profileif neededNo indication specific to withdrawal: cardiovascular risk screening according to the usual rules, if not up to date (see the page “Dyslipidaemia”).
• Fasting plasma glucoseif neededNo indication specific to withdrawal: diabetes screening according to the usual rules, if not up to date (see the page “Type 2 diabetes”).
• Serum magnesiumif neededWithdrawal with gastrointestinal losses (vomiting, diarrhoea) or malnourished patient: the SFA asks for electrolyte disturbances to be corrected, hypokalaemia by giving potassium and magnesium together, and for magnesium supplementation to be considered in the malnourished patient ^[2], and INESSS (Quebec) includes serum magnesium in the baseline tests for withdrawal ^[3].
• HIV serologyif neededRisk factor for HIV infection, with the patient's consent ^[2].
• Hepatitis B serology (HBsAg, anti-HBs antibodies, anti-HBc antibodies)if neededRisk factor (history of drug use, especially intravenous, unprotected sex…) or raised transaminases, especially predominantly ALT ^[2]. The AFEF recommends screening at least once in a lifetime ^[2].
• Hepatitis C serologyif neededRisk factor (history of drug use, especially intravenous, unprotected sex…) or raised transaminases, especially predominantly ALT ^[2]. The AFEF recommends screening at least once in a lifetime ^[2].
• Syphilis serologyif neededSexual risk behaviour: consider STI screening, including syphilis, in people with a substance use disorder ^[4] (see the page “Sexually transmitted infections (STIs)”).
• Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR) (on urine, vaginal, anal and/or pharyngeal sample)if neededSexual risk behaviour ^[4]: sample one or more sites according to practices and exposure (throat, anus, vagina or first-void urine); procedures 5302 and 5303 for 2 or 3 sites, on explicit prescription ^[5]. See the page “Sexually transmitted infections (STIs)”.
• hCGif neededWoman of childbearing potential: pregnancy makes alcohol misuse an addiction-medicine priority ^[2] and prompts consideration of inpatient withdrawal ^[2].
• Vitamin B9 (folate)if neededMalnutrition or macrocytosis, both frequent in alcohol misuse ^[2].
• Vitamin B12 (mind the transport)if neededMalnutrition or macrocytosis, both frequent in alcohol misuse ^[2].
• Urine drug screen (if concomitant use of benzodiazepines or other substances suspected)if needednon-French guidelineSuspected co-use: in the United States, the ASAM (2020) suggests a urine or other toxicology test to detect polysubstance use before withdrawal, and the Australian guidelines (2021) consider urine tests sometimes useful during outpatient withdrawal ^[6,7]. For the SFA, co-use of high-dose benzodiazepines favours inpatient withdrawal, but it does not provide for this test ^[2]. Reimbursed by the French health insurance only for emergency diagnosis and therapeutic monitoring ^[8].