Recognition and Management of Withdrawal Delirium (Delirium Tremens)

Abstract

A t some time in their lives, 20% of men and 10% of women in most Western societies will have an alcohol-use disorder, which is defined as repetitive alcohol-related problems in at least 2 of 11 areas of life. 1,2 These conditions can decrease the life span by a decade and are associated with severe impairments in social functioning, as well as high rates of medical problems. Although alcohol-related conditions occur in persons from all social strata and affect more than 20% of patients in most medical settings, 2,3 few physicians have been adequately trained in identifying and treating these serious problems.About 50% of persons with alcohol-use disorders have symptoms of alcohol withdrawal when they reduce or discontinue their alcohol consumption; in 3 to 5% of these persons, grand mal convulsions, severe confusion (a delirium), or both develop. 1 It is essential that clinicians know how to prevent, recognize, and treat these severe withdrawal states to minimize costly hospitalizations and avoidable deaths.

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

“…Physical examination and investigations should be directed toward detecting common signs and symptoms of AWS that are listed in Table 1 6, 10, 14, 15, 16, 17, 18…”

“…They can last up to 6 d. The appearance of acute symptomatic seizures may emerge 6–48 h after the last drink 19. Delirium tremens (DT, onset 48–72 h after cessation of drinking) represents characteristics of severe withdrawal that may last for up to 2 weeks (late withdrawal) 6, 10, 15, 18. The chronological development of the various symptoms is illustrated in Fig.…”

“…Hallucinosis represents a unique form of withdrawal‐related psychosis which can begin even while the person is continuing to use alcohol or after cessation of drinking. The sensorium is clear in the beginning, but it often evolves into the syndrome of DT, a specific type of delirium typically associated with psychomotor agitation (hyperactive delirium) which emerges during the late withdrawal phase 14, 18. Delirium can also manifest as a hypoactive state with decreased arousal and psychomotor activity, which is associated with a worse prognosis, delayed diagnosis and treatment as well as later complications 6.…”

The Prevalence of Alcohol Consumption and Common Influencing Factors to Start Alcohol Consumption in Early Age: Health Fair Study in Dominica

“…These changes maintain the person with compulsive inability to stop drinking alcohol and results to alcohol withdrawal syndrome if the person stops. Alcoholism reduces a person's life expectancy by around ten years [28] and alcohol use is the third leading cause of early death in the United States. There is greater risk in younger people due to binge drinking which may result in violence or accidents [29].…”

Delirium: an update for internists and psychiatrists

“…Hasta 15% de los pacientes hospitalizados con síndrome de abstinencia alcohólica pueden experimentar convulsiones tónico-clónicas generalizadas y 5% desarrolla "delirium tremens", una combinación de excitación del sistema nervioso central (agitación, delirium y convulsiones) y síntomas hiperadrenérgicos (23) (hipertensión, taquicardia y arritmias), con riesgo para la vida .…”