Pathophysiology
Clinical meaning
Alcohol is a central nervous system (CNS) depressant that enhances inhibitory GABA activity and suppresses excitatory glutamate (NMDA) signaling. Chronic alcohol use causes neuroadaptive upregulation of NMDA receptors and downregulation of GABA receptors. When alcohol is abruptly discontinued, unopposed excitatory neurotransmission produces autonomic hyperactivity—tachycardia, hypertension, diaphoresis, tremors—progressing to seizures and potentially fatal delirium tremens. Symptoms begin 6-24 hours after the last drink. The nurse monitors vital signs, observes for escalating symptoms, administers medications as ordered, and reports changes immediately.