alcohol withdrawal delirium

Delirium tremens

Delirium tremens (DTs; lit. 'mental disturbance with shaking') is a rapid onset of confusion caused by withdrawal from alcohol. DT typically occurs 48–72 hours after the last use of alcohol and symptoms last 1–8 days. Typical symptoms include nightmares, confusion, disorientation, heavy sweating, elevated heart rate, and elevated blood pressure. Visual, auditory, and tactile hallucinations are also common. DT can be fatal especially without treatment. Occasionally, a very high body temperature or seizures (colloquially known as "rum fits") may result in death. Other causes of death include respiratory failure and cardiac arrhythmias. Delirium tremens typically occurs only in people with a high intake of alcohol for prolonged periods of time, followed by sharply reduced intake. A similar syndrome may occur with benzodiazepine and barbiturate withdrawal; however, the term delirium tremens is reserved for alcohol withdrawal. In a person with delirium tremens, it is important to rule out other associated problems such as electrolyte abnormalities, pancreatitis, and alcoholic hepatitis. Prevention is by treating withdrawal symptoms using similarly acting compounds to taper off the use of the precipitating substance in a controlled fashion. If delirium tremens occurs, aggressive treatment with benzodiazepines improves outcomes. Treatment in a quiet intensive care unit with sufficient light is often recommended to re-orient the patient. Benzodiazepines are the medication of choice with short acting compounds including lorazepam and oxazepam commonly used, which bypass the liver...