The death of Joanna Ruth Shields, the 37-year-old woman who was found along a remote Big Sur hiking trail in April, has cast a spotlight on a little-known but deadly affliction: alcohol withdrawal syndrome.

According to an investigation by the the Monterey County Sheriff’s Office, the Carlsbad native had died of “probable alcohol withdrawal seizures due to chronic alcohol use disorder.”

For months, mystery had swirled surrounding the death of Shields, who was found on the near Sykes Hot Springs, naked except for a black bra, with a gash above her eye and suspicious marks on her neck.

However, the autopsy determined that the facial laceration was a superficial wound that didn’t contribute to her death, while the neck markings were from “post-mortem” insect bites rather than evidence of strangulation or any criminal act.

“Investigators found no evidence during the forensic examination or throughout the investigation to indicate that Ms. Shields was the victim of a crime,” they wrote.

According to investigators, Shields had a history of bipolar disorder and alcoholism while her sister noted that she suffered alcohol withdrawal seizures before, but had previously not experienced one since becoming sober.

How can quitting alcohol become life-threatening? Here’s what we know about the condition.

Alcohol withdrawal syndrome

While getting off the sauce is often considered a good thing, quitting cold turkey can prove problematic due to alcohol’s sedative effect on the brain.

When someone drinks for a prolonged period, their brain chemistry adjusts to compensate for booze’s depressant effects.

Stopping abruptly can result in overstimulation that experts have compared to “accelerating vehicle that has lost its brakes,” according to Harvard Medical School.

Symptoms and complications

According to the Cleveland Clinic, withdrawal symptoms generally begin to appear between six and 12 hours of a chronic user’s last drink. The initial signs can include headache, mild anxiety, irritability, shaking, and insomnia.

Within 24 hours, the user can even experience hallucinations that can sometimes last for days.

These visions can be “very detailed and imaginative” with some patients reporting seeing “multiple small, similar, moving objects” such as “crawling insects or falling coins,” according to the Harvard Med School release.

While symptoms may resolve on their own in people with mild to moderate withdrawal, patients with severe or complicated condition can suffer from hours-long, life-threatening seizures, with the greatest risk occurring 24 to 48 hours after they quit drinking.

One of the most serious complications is delirium tremens, a potentially fatal condition marked by disruptions in respiration, circulation, and temperature regulation. Suffers can experience a racing heart, blood pressure fluctuations, and even a temporary reduction in blood flow to the brain.

This frightening symptom occurring two to three days after the last drink, but can be delayed by more than a week.

Risk factors

Alcohol withdrawal can occur if someone stops using or significantly curtails the amount of booze they consume after two weeks of heavy use, as defined by the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Heavy use among men is generally defined five or more alcoholic drinks on any day or 15 or more per week. For women, it means imbibing four or more on any day or eight or more drinks per week.

Along with heavy alcohol use, alcohol withdrawal risk can be heightened by dehydration, coexisting health conditions, electrolyte imbalances, abnormal liver function, a history of deliriums tremens or alcohol related seizures, and if the person is older than 65.

Treatment

And while many peoples’ condition improves sans medical intervention, those with moderate cases may require medications such as Diazepam or Lorazepam to mitigate risk of seizures and the development of delirium tremens.

Failing that, beta-blockers or clonidine may be prescribed for constant high blood pressure and an accelerated heart rate.

Severe cases — especially those involving delirium tremens — may require the patient to be treated at the hospital or ICU.

In these instances, symptoms will be managed with long-acting benzodiazepines administered via IV, during which healthcare providers will monitor patients’ vitals continuously to ensure they don’t develop serious complications.

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