LIFE-THREATENING COMPLICATIONS OF ALCOHOL WITHDRAWAL SYNDROME IN HOSPITALIZED PATIENTS: CLINICAL PRACTICE AND SYSTEMIC BARRIERS IN POLISH AND CENTRAL-EUROPEAN SETTINGS

Alcohol withdrawal syndrome remains a common and potentially life-threatening condition in hospitalized patients with alcohol use disorder, contributing to prolonged ICU stays, mechanical ventilation, and preventable mortality. Severe complications - delirium tremens, seizures, and Wernicke’s encephalopathy - are particularly frequent in Central and Eastern Europe due to gaps in risk stratification, limited availability of adjunctive therapies, and systemic barriers. Although benzodiazepines remain first-line treatment in Polish guidelines, benzodiazepine-resistant AWS occurs in approximately 10 % of severe cases and is associated with excessive sedative requirements and respiratory complications. Mounting evidence supports phenobarbital as a safe and effective alternative or early adjunct in severe/refractory AWS owing to its dual GABA-A potentiation and glutamate (NMDA/AMPA) antagonism, predictable pharmacokinetics, and favourable impact on ICU length of stay, intubation rates, and overall costs. Despite these advantages, phenobarbital use in Poland is limited by its narcotic classification, pharmacy restrictions, and lack of standardised protocols. Additional regional challenges include the absence of parenteral thiamine formulations >100 mg and the lack of a national AWS registry. This narrative review synthesises current evidence on epidemiology, risk stratification, phenobarbital-based protocols, high-dose thiamine/magnesium repletion, and systemic barriers in Poland and neighbouring countries. Practical, immediately implementable recommendations are provided for Polish hospitals, including selective PAWSS screening, phenobarbital loading regimens, strategies to overcome narcotic legislation and thiamine limitations, minimal-burden registry models, and expanded use of reimbursed addiction teleconsultations. Adoption of these measures has the potential to substantially reduce severe complications and resource utilisation in resource-constrained Central-European settings.