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Alcohol Withdrawal Delirium (Delirium Tremens)

Introduction

Delirium Tremens is an acute episode of delirium that is usually caused by withdrawal from alcohol. Although the typical delirium occurs 2–3 days following cessation of prolonged alcohol intake, reaching a peak at around 5 days, some withdrawal symptoms such as tremor may start within 12 hours.

Risk Factors

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Signs and symptoms

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Diagnostic criteria

• Visual hallucinations
• Disorientation
• Fluctuating level of consciousness
• Agitation
• Tachycardia
• Hypertension
• A low-grade fever may be present
• Withdrawal tonic-clonic seizures may occur between 24 and 48 hours following cessation of alcohol intake

Note:

It is important to consider alternative causes, when making the diagnosis. This is especially true for cases with an atypical presentation.

Investigations

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Managemet

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  • Non-pharmacological

    Emergency Care

    • Secure airway
    • Ensure breathing
    • Circulation
    • Give IV fluid (Dextrose Normal Saline) to prevent hypoglycaemia and hypotension
    • Monitor for respiratory depression

  • Pharmacological

    • Diazepam IV 10 mg
    OR
    • Lorazepam IM/IV, 2 mg for immediate sedative or hypnotic action. If no response give a second dose.

    Note:

    • Do not administer at a rate over 5 mg/minute
    • Switch to oral once containment is achieved
    OR
    • Chlordiazepoxide 20–60mg taper over one month

    AND
    • Thiamine IM 300mg daily
    OR
    • Vitamin B Complex 1 ampoule in half litre of 5% Dextrose 12. 10.4. Cocaine

Prevention

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Updated on,

20 Novemba 2020, 17:59:31

References

    1. STG
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