delirium tremens (DT's)
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Introduction
Is a serious, potentially fatal complication of alcohol withdrawal syndrome.
Epidemiology
- 5% of patients hospitalized for alcohol withdrawal
Clinical manifestations
- onset:
- may begin as early as 1-3 days after EtOH cessation
- 48-96 hours after last drink
- peak incidence in 4-5 days
- gross tremors
- seizures
- incontinence
- frightening visual hallucinations
- ataxia
- vestibular dysfunction
- autonomic lability
- delirium
Laboratory
- complete blood count (CBC) with differential
- serum chemistries
- PT/aPTT, INR
- hepatitis serologies (B & C)
- urinalysis
- urine toxicology
- CSF analysis
Diagnostic procedures
Radiology
Management
- transfer to the ICU & sedate +/- mechanical ventilation for combativeness, agitation & confusion not responding to benzodiazepine or antipsychotic[5]
- vitals every 6 hours
- low stimulation environment
- rehydration
- pharmaceutical agents
- prognosis
- generally clear in 12-24 hours
- 20% mortality without treatment; 1% with appropriate therapy
* Caution: neuroleptics can decrease the threshold for seizures
More general terms
References
- ↑ Diagnostic History & Physical Examination in Medicine, Chan & Winkle, Current Clinical Strategies, Laguna Hills, CA 1996
- ↑ Mayo-Smith MF, Beecher LH, Fischer TL, Gorelick DA, Guillaume JL, Hill A, Jara G, Kasser C, Melbourne J; Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. 2004 Jul 12;164(13):1405-12. Erratum in: Arch Intern Med. 2004 Oct 11;164(18):2068. dosage error in text. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15249349 <Internet> http://archinte.ama-assn.org/cgi/content/abstract/164/13/1405
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
- ↑ Schuckit MA Recognition and Management of Withdrawal Delirium (Delirium Tremens). N Engl J Med 2014; 371:2109-2113. November 27, 2014 http://www.nejm.org/doi/full/10.1056/NEJMra1407298
- ↑ 5.0 5.1 5.2 NEJM Knowledge+ Psychiatry