The death of Joanna Ruth Shields, 37, who was found along a remote Big Sur hiking trail in April, has been attributed to probable alcohol withdrawal seizures resulting from chronic alcohol use disorder, according to an investigation by the Monterey County Sheriff’s Office.
For months, mystery surrounded the death of Shields, who was discovered near Sykes Hot Springs. Initial reports noted she was found without clothing except for a black bra, with a gash above her eye and marks on her neck. However, the autopsy concluded that the facial laceration was superficial and did not contribute to her death. The markings on her neck were determined to be from post-mortem insect bites, and investigators found no evidence of criminal activity.
Investigators stated that Shields had a history of bipolar disorder and alcoholism. Her sister noted that Shields had previously experienced alcohol withdrawal seizures but had not had one since becoming sober.
Quitting alcohol abruptly after prolonged, heavy use can lead to dangerous consequences due to alcohol's sedative effect on the brain. When an individual drinks consistently, their brain chemistry adapts to the depressant effects of alcohol. Sudden cessation can cause overstimulation, a phenomenon that medical experts have likened to an accelerating vehicle that has lost its brakes.
Alcohol Withdrawal Symptoms and Complications
According to the Cleveland Clinic, withdrawal symptoms can emerge between six to 12 hours after a chronic user's last drink. Initial signs may include headache, anxiety, irritability, shaking, and insomnia. Within 24 hours, individuals may experience hallucinations, which can sometimes persist for days. These can be highly detailed, with some patients reporting visual disturbances like crawling insects or falling coins.
While symptoms might resolve independently in cases of mild to moderate withdrawal, severe or complicated withdrawal can lead to life-threatening seizures. The risk of seizures is highest between 24 to 48 hours after abstaining from alcohol.
A serious complication is delirium tremens (DTs), a potentially fatal condition that disrupts respiration, circulation, and temperature regulation. Symptoms can include rapid heart rate, blood pressure fluctuations, and reduced blood flow to the brain. DTs typically occur two to three days after the last drink but can be delayed for over a week.
Risk Factors and Treatment
Alcohol withdrawal can occur after stopping or significantly reducing alcohol consumption following at least two weeks of heavy use. Heavy drinking is defined by the U.S. National Institute on Alcohol Abuse and Alcoholism as consuming five or more alcoholic drinks on any day or 15 or more per week for men, and four or more on any day or eight or more per week for women.
Factors that can heighten the risk of alcohol withdrawal include dehydration, coexisting health conditions, electrolyte imbalances, abnormal liver function, a history of delirium tremens or alcohol-related seizures, and age over 65.
Medical professionals may prescribe medications such as diazepam or lorazepam to mitigate the risk of seizures and delirium tremens. Beta-blockers or clonidine may be used to manage persistent high blood pressure and elevated heart rate.
Severe cases, particularly those involving delirium tremens, may necessitate hospitalization or intensive care. In such settings, patients receive long-acting benzodiazepines intravenously, with continuous monitoring of vital signs to prevent serious complications.