Neurology

Alcohol Withdrawal & GABA: Mechanism

MECHANISM: Abrupt withdrawal is thought to reduce inhibitory neurotransmission and enhance excitatory neurotransmission.

  • Caused by the effects of alcohol on GABA receptors (enhances γ-aminobutyric acid)
  • Constant consumption of alcoholic beverages will down regulate these GABA-receptors in order to maintain homeostasis!
  • There is a counter up regulation of excitatory neurotransmitters (i.e Glutamate) => Think of it like a see-saw trying to balance! (see image) 
    • When alcohol is no longer consumed
    • Down-regulated GABA receptor complexes are so insensitive to GABA that the typical amount of GABA produced has little effect
  • Compounded with the fact that GABA normally inhibits action potential formation (there are not as many receptors for GABA to bind to aka Tachyphylaxis); sympathetic activation is unopposed!!! (i.e tachycardia, hypertension, tremulousness, and hyperreflexia)

REFERENCES

  1. Bayard M, McIntyre J, Hill KR, Woodside J Jr. Alcohol withdrawal syndrome. Am Fam Physician. 2004 Mar 15;69(6):1443-50.
  2. Chapter 5. Environmental and Nutritional Pathology. Pathology: The Big Picture. Walter L. Kemp, Dennis K. Burns, Travis G. Brown. Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved.
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Dr. C Humphreys

Internal Medicine

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