Pathophysiology 1
AWS develops due to an imbalance in neurotransmitters in patients’ brains caused by chronic consumption of alcohol or to give it its proper name ethanol.
The two key neurotransmitters involved are GABA which is inhibitory and NDMA which is excitatory. In health these are balanced as shown below:
Pathophysiology 2
Ethanol acts on GABA receptors potentiating their inhibitory effects. To maintain homeostasis the neurones down regulate GABA and upregulate NDMA:
Pathophysiology 3
On cessation of drinking ethanol is removed causing imbalance in the neurotransmitters leading to hyper-excitability:
This hyper-excitability leads to the clinical syndrome known as alcohol withdrawal syndrome. It is worth noting that only a drop in ethanol levels is required to cause this imbalance so patients can still show symptoms of withdrawal despite still having a detectable blood alcohol level8.
Great concept in teaching this
lovely illustration.