Original article| Volume 10, ISSUE 2, P112-116, July 1999

Fever during alcohol withdrawal syndrome


      Background: Fever is considered common during alcohol withdrawal, but there are very few reports focused on this problem. The aim of the present study was to evaluate the prevalence and causes of fever in patients admitted to the hospital with alcohol withdrawal syndrome. Methods: A total of 110 episodes of alcohol abstinence syndrome (10 cases of tremulousness and anxiety, 38 of delirium, and 62 cases of seizure) in 98 patients admitted to the hospital for that reason (82 males and 12 females, median age 42 years, range 18–72 years) were reviewed. Cases with fever on admission were not included. Results: Seventy-two cases (65%) presented low-grade fever (maximum axillary temperature 37–37.9°C), and 23 cases (21%) presented high-grade fever (≥38°C). Pyrexia appeared after a median of 2 days in the hospital (range 1–8 days). The prevalence of fever was similar among the different alcohol withdrawal syndromes. Catheter-associated phlebitis was the cause of pyrexia in 39 cases (41%). Respiratory infection was present in 15 cases of pyrexia (16%) and urinary tract infection in 11 (12%). Patients with low serum albumin levels had a higher rate of both respiratory and urinary tract infection. Ten patients (12%) had more than one cause of fever. In 38 cases of pyrexia (40%), no cause was identified. This was more frequent in low-grade fever (33 cases, 46%) than in high-grade fever (five cases, 22%). All cases of pyrexia without an obvious cause resolved spontaneously after a median of 3 days. Conclusions: Pyrexia is very common during alcohol withdrawal syndrome. A cause may frequently be identified, particularly in patients with high-grade fever. Many patients have transient pyrexia (mostly low-grade fever) without an obvious cause.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Adams RD, Victor M, Ropper AH. Alcohol and alcoholism. In: Adams RD, Victor M, Ropper AH, editors. Principles of Neurology. New York: McGraw-Hill, 1997:1166–85.

        • Wrenn KD
        • Larson S
        The febrile alcoholic in the emergency department.
        Am J Emerg Med. 1991; 9: 57-60
        • Tavel ME
        • Davidson W
        • Batterton TD
        A critical analysis of mortality associated with delirium tremens.
        Am J Med Sci. 1961; 242: 18-29
        • Rose HD
        • Golbert TM
        • Sanz CJ
        • Leitschuh TH
        Fever during acute alcohol withdrawal.
        Am J Med Sci. 1970; 260: 112-121
        • Wachtel TJ
        • Steele GH
        • Day JA
        Natural history of fever following seizure.
        Arch Intern Med. 1987; 147: 1153-1155
        • Gippini A
        • Rodriguez I
        • Torre A
        • Tomé S
        • Barrio E
        Sı́ndrome de abstinencia alcohólica en el Servicio de Medicina Interna de un hospital general; epidemiologı́a y coste hospitalario.
        Ann Med Intern (Madrid). 1990; 7: 11-13
      2. Dinarello CA, Wolff SM. Pathogenesis of fever and the acute phase response. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. New York: Churchill Livingstone, 1995:530–36.

        • Garner JS
        • Jarvis WR
        • Emori TG
        • Horan TC
        • Hughes JM
        CDC definitions for nosocomial infections.
        Am J Infect Control. 1988; 16: 128-140
        • Sternbach GL
        Infections in alcoholic patients.
        Emerg Med Clin North Am. 1990; 8: 793-803
        • Martı́nez JA
        • Fernández P
        • Rodrı́guez E
        • et al.
        Catéteres intravenosos: complicaciones derivadas de su utilización y análisis de los factores predisponentes.
        Med Clin (Barcelona). 1994; 103: 89-93
        • Ruiz-Laiglesia FJ
        • Torrubia-Pérez CB
        • Reclusa-Poyo F
        • Arnal-Rubio N
        Flebitis en catéteres intravenosos periféricos.
        Med Clin (Barcelona). 1994; 103: 116-117
        • Tomford JW
        • Hershey CO
        • McLaren CE
        • Porter DK
        • Cohen DI
        Intravenous therapy team and peripheral venous catheter-associated complications. A prospective controlled study.
        Arch Intern Med. 1984; 144: 1191-1194
        • May J
        • Murchan P
        • MacFie J
        • et al.
        Prospective study of the etiology of infusion phlebitis and line failure during peripheral parenteral nutrition.
        Br J Surg. 1996; 83: 1091-1094
        • Maki DG
        • Ringer M
        Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial.
        Ann Intern Med. 1991; 114: 845-854
        • Spies CD
        • Dubisz RA
        • Neumann T
        • et al.
        Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of prospective, randomized trial.
        Crit Care Med. 1996; 24: 414-422
        • Gluckman SJ
        • Dvorak VC
        • McGregor RR
        Host defenses during prolonged alcohol consumption in a controlled environment.
        Arch Intern Med. 1977; 137: 1539-1543
        • McGregor RR
        • Gluckman SJ
        • Senior JR
        Granulocyte function and levels of immunoglobulins and complement in patients admitted for withdrawal from alcohol.
        J Infect Dis. 1978; 138: 747-753
        • Baker RC
        • Jerrels TR
        Recent developments in alcoholism: immunological aspects.
        Recent Dev Alcohol. 1993; 11: 249-271
        • Wallaert B
        • Aerts C
        • Colombel JF
        • Voisin C
        Human alveolar macrophage antibacterial activity in the alcoholic lung.
        Am Rev Respir Dis. 1991; 144: 278-283
        • Pitts TO
        • Van Thiel DH
        Urinary tract infections and renal papillary necrosis in alcoholism.
        Recent Dev Alcohol. 1986; 4: 341-355
        • Llach J
        • Rimola A
        • Navasa M
        • et al.
        Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration.
        Hepatology. 1992; 16: 724-727
        • Yoshida H
        • Hamada T
        • Inuzuka S
        • Ueno T
        • Sata M
        • Tanikawa K
        Bacterial infection in cirrhosis, with and without hepatocellular carcinoma.
        Am J Gastroenterol. 1993; 88: 2067-2071
        • Bercault N
        • Martin P
        • Hatahet Z
        • Gueveler C
        Hyperthermie maligne lors du sevrage alcoolique.
        Rev Med Intern. 1989; 10: 203-205
      3. Sherlock S, Dooley J. Alcohol and the liver. In: Sherlock S, Dooley J, editors. Diseases of the Liver and the Biliary System. Oxford: Blackwell, 1997:385–403.

        • Ryback RS
        • Eckardt MJ
        • Felsher B
        • Rawlings RR
        Biochemical and hematologic correlates of alcoholism and liver disease.
        JAMA. 1982; 248: 2261-2265