Delirium tremens: early diagnosis and intensive care guidelines. Review

Muronov, A.Ye.

doi:10.21320/1818-474x-2020-1-53-65

Annals of Critical Care

2020

DOI: 10.21320/1818-474x-2020-1-53-65

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Delirium tremens: early diagnosis and intensive care guidelines. Review

A.Ye. Muronov

Abstract: Alcoholic delirium is a formidable complication of severe alcohol withdrawal syndrome. It is often formed in patients of hospitals and departments of anesthesiology and intensive care, as a result of the forced cessation of alcohol consumption. Its formation is associated with an increase in the length of hospital stay and mortality. The review discusses modern approaches to the diagnosis, especially early, of this condition, its intensive care and methods of non-drug correction.

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2021

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Cited by 2 publications

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Delirium in Acute Poisoning with 1,4-Butanediol and Its Correction

Sinenchenko

Lodyagin

Sinenchenko

et al. 2021

Obŝaâ reanimatologiâ

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Delirium complicating regular use of psychoactive substances remains one of the major issues of critical care, toxicology, and psychiatry. However, the pathogenetic mechanisms of delirium development in patients with 1,4-butanediol poisoning have been poorly studied until now.The aim of the study was to reveal specific patterns of delirium in patients with 1,4-butanediol poisoning as well as to study the changes in systemic hemodynamic parameters, respiratory function, and body fluid compartments during the treatment.Material and methods. The study was prospective and treatment-randomized. Forty-eight male patients aged 20 to 45 years with delirium and acute 1,4-butanediol poisoning were enrolled. Of them, 24 patients were administered with succinate-containing drug 40 ml daily, 24 patients received standard treatment without antihypoxic agents. We studied the evolution of delirium, changes in anaerobic metabolism parameters, systemic hemodynamics, respiratory function, and the volume of fluid compartments. Impedance measurement method adjusted for interference was used in the study.Results. At the «peak» of delirium (days 1–3), the hyperdynamic circulation, increased systemic arterial tone, stroke output, respiratory function parameters, and metabolic lactate acidosis were recorded. A decrease in total fluid volume and extracellular fluid volume was clearly observed during day 1 of intoxication delirium along with increased permeability of cell membranes. On day 3 of delirium, a decrease in intracellular fluid volume and increase in extracellular fluid volume were noted. After the cytoflavin administration, shorter delirium duration (7.5 [6; 8] days), more rapid correction of lactate acidosis, stabilization of respiratory parameters and stabilization of cell membrane permeability by day 5 were found. In the control group, delirium persisted for up to 14 [11; 15] days (z=-5.9; P=0.00011) with more frequent development of complications such as nosocomial pneumonia (χ2=8.4, P<0.001).Conclusion. The severity of delirium in acute poisoning with 1,4-butanediol was associated with metabolic lactate acidosis, changes in systemic hemodynamics and pulmonary function. A positive effect of adjunctive antihypoxic therapy with succinate-containing agent on cardio-respiratory parameters, cell membrane permeability, water balance due to elimination of tissue hypoxia and prompt switching to tissue aerobic metabolism has been found.

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Delirium in Acute Poisoning with 1,4-Butanediol and Its Correction

Sinenchenko

Lodyagin

Sinenchenko

et al. 2021

Obŝaâ reanimatologiâ

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Features of metabolic disorders and risk factors of delirium complications in acute severe ethanol poisoning

Sinenchenko¹,

Lodyagin²,

Коваленко³

et al. 2021

Anaes. i reanim.

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Delirium tremens: early diagnosis and intensive care guidelines. Review

Cited by 2 publications

References 82 publications

Delirium in Acute Poisoning with 1,4-Butanediol and Its Correction

Delirium in Acute Poisoning with 1,4-Butanediol and Its Correction

Features of metabolic disorders and risk factors of delirium complications in acute severe ethanol poisoning

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