Skip to main content

Delirium Tremens

Image
By

Delirium Tremens

Delirium Tremens is an emergent situation, that we may regard as the most severe form of alcohol withdrawal syndrome. In most cases, it occurs after long-term heavy use. It may also occur in patients who stop benzodiazepines. 

In most cases, it occurs after long-term heavy use of alcohol. 

Presentation

Psychological and behavioural manifestations

  1. Rapidly changing picture

Clouding of Consciousness

  1. Disorientation
  2. Disorganised mental activity
  3. Short term memory disturbance

Perceptual abnormalities

  1. Hallucinations
  2. Visual misinterpretations
  3. Illusions
  4. Cocaine bugs (formication)

Behavioural manifestations

  1. Agitation
  2. Shouting
  3. Restlessness
  4. Fear
  5. Sleeplessness 

Physical Manifestations

General Physical

  1. Dehydration
  2. Electrolyte disturbances

Autonomic Manifestations

Autonomic manifestations of delirium tremens differentiate it from delirium (acute confusional state) that occurs because of organic causes other than substance use and alcohol withdrawal. 
  1. Sweating 
  2. Fever
  3. tachycardia
  4. Raised blood pressure 
  5. Dilation of pupils

Complications

  1. Over salivation
  2. Aspiration pneumonia
  3. Cardiac arrhythmia 

Management

Recognition

Clinicians need to increase their sensitivity to suspect and recognise delirium tremens in people at risk.

Intensive care

We manage patients diagnosed with delirium tremens in the intensive care unit; delirium is a medical emergency, and delirium tremens is the worse form of it. 

Supportive Management

  1. Magnesium, dextrose, and folic acid supplements for all patients
  2. Prevention of seizures.
    1. Very-High-Bolus benzodiazepine therapy.
    2. If the above is not effective, then use phenobarbital.
    3. For patients who have fits despite the above, use anaesthesia 
  3. Give thiamine to prevent Wernicke encephalopathy. 
    1. We give this to all patients who are in alcohol withdrawal state or delirium tremens.
  4. Ventilation for patients with respiratory arrest.

The best choice of treatment for delirium tremens

  1. Benzodiazepines such as diazepam may worsen symptoms of delirium but not in alcohol withdrawal delirium, (I think) because of cross-tolerance. 
  2. Haloperidol is an excellent choice for treating delirium except if the cause is a neuroleptic malignant syndrome, delirium tremens, Lewy-body dementia, or Parkinson's disease. 
  3. Antipsychotics cause adverse reactions in patients with Lewy-body dementia, worsens parkinsonian symptoms, and may reduce the seizure threshold in those with delirium tremens, and may increase the risk of arrhythmias because of QTc prolongation. 
  4. Haloperidol does not reduce the seizure threshold as much as other antipsychotics but is notorious for arrhythmias. 


Labels:

Comments

Post a Comment

Your Thoughts?

Popular posts from this blog

ADVOKATE: A Mnemonic Tool for the Assessment of Eyewitness Evidence

By
ADVOKATE: A Mnemonic Tool for Assessment of Eyewitness Evidence A tool for assessing eyewitness  ADVOKATE is a tool designed to assess eyewitness evidence and how much it is reliable. It requires the user to respond to several statements/questions. Forensic psychologists, police or investigative officer can do it. The mnemonic ADVOKATE stands for: A = amount of time under observation (event and act) D = distance from suspect V = visibility (night-day, lighting) O = obstruction to the view of the witness K = known or seen before when and where (suspect) A = any special reason for remembering the subject T = time-lapse (how long has it been since witness saw suspect) E = error or material discrepancy between the description given first or any subsequent accounts by a witness.  Working with suspects (college.police.uk)
Post a Comment
Read more

ICD-11 Criteria for Anorexia Nervosa (6B80)

By
ICD-11 Criteria for Anorexia Nervosa (6B80) Anorexia Nervosa is characterised by significantly low body weight for the individual’s height, age and developmental stage that is not due to another health condition or to the unavailability of food. A commonly used threshold is body mass index (BMI) less than 18.5 kg/m2 in adults and BMI-for-age under 5th percentile in children and adolescents. Rapid weight loss (e.g. more than 20% of total body weight within 6 months) may replace the low body weight guideline as long as other diagnostic requirements are met. Children and adolescents may exhibit failure to gain weight as expected based on the individual developmental trajectory rather than weight loss. Low body weight is accompanied by a persistent pattern of behaviours to prevent restoration of normal weight, which may include behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g. self-induced vomiting, misuse of laxatives), and behaviours aimed at incr
Post a Comment
Read more

ICD-11 Criteria for Schizophrenia (6A20 )

By
ICD-11 Criteria for Schizophrenia (6A20 ) Schizophrenia is characterised by disturbances in multiple mental modalities, including thinking (e.g., delusions, disorganisation in the form of thought), perception (e.g., hallucinations), self-experience (e.g., the experience that one's feelings, impulses, thoughts, or behaviour are under the control of an external force), cognition (e.g., impaired attention, verbal memory, and social cognition), volition (e.g., loss of motivation), affect (e.g., blunted emotional expression), and behaviour (e.g., behaviour that appears bizarre or purposeless, unpredictable or inappropriate emotional responses that interfere with the organisation of behaviour). Psychomotor disturbances, including catatonia, may be present. Persistent delusions, persistent hallucinations, thought disorder, and experiences of influence, passivity, or control are considered core symptoms. Symptoms must have persisted for at least one month in order for a diagnosis of schi
Post a Comment
Read more