Delirium Tremens
It’s basically autonomic anarchy - Diane M. Birnbaumer MD
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Delirium Tremens...
True DT is still associated with significant mortality, somewhere between 5% and 30%. Trying to quantify this more precisely is difficult because many of these patients have severe concomitant injuries and illnesses.
Historically, patients with DT were cared for in psychiatric settings, with mortality and morbidity generally attributed to inadequate sedation, sympathetic overload and eventual cardiovascular collapse. As sophistication with medical intensive care advanced, so did the treatment of DT
Resources
Alcohol Withdrawal and Delirium Tremens: Diagnosis and Management
In patients who are suffering from delirium, keep a broad differential diagnosis including infection, other toxidromes (sympathomimetics, anticholinergics, toxic alcohols), serotonin syndrome, NMS, hypertensive crisis, acute pain and thyrotoxicosis.
Dealing with the DTs
Late alcohol withdrawal is also known as delirium tremens—the DTs—and consists of the worsening autonomic dysregulation that is responsible for the morbidity and mortality attributed to alcohol withdrawal. It begins after early withdrawal—usually 72 hours or more after the last drink.
Management of Delirium Tremens
The treatment for alcohol withdrawal is a benzodiazepine. I honestly don’t think the benzo you choose matters that much. I use diazepam because its maximal effect intravenously is seen at about 5 minutes, so it is easily and safely titrated and its long half life provides some degree of auto-taper. My first dose is 10mg, and this dose is repeated once at 5 minutes if response is not adequate.
Morning Report: Delirium Tremens
Be Aggressive, may require bigger dose of benzos than you’re used to, up to 200-300mg. Target the HR in your management. Higher mortality rates associated with electrolye and metabolic derangements.
Delirium Tremens...
In many cases, the diagnosis of DT is not difficult. Patients have a clear history of alcohol dependence with abrupt discontinuation and progress from less severe manifestations of alcohol withdrawal such as anxiety, seizures and tremulousness. This pathological process usually occurs over several days, with frank DT beginning approximately 2-5 days after cessation of alcohol consumption. In patients with very heavy alcohol consumption, the process may occur when there is still a substantial amount of alcohol in the blood.
EMRounds
>50 mg valium or >10 mg ativan is required in 1st hour...
StatPearls
Delirium tremens was first recognized as a disorder attributed to excessive alcohol abuse in 1813. It is now commonly known to occur as early as 48 hours after abrupt cessation of alcohol in those with chronic abuse and can last up to 5 days. It has an anticipated mortality of up to 37% without appropriate treatment. It is crucial to identify early signs of withdrawal because it can become fatal.
WikEM
Generally a clinical diagnosis, however comorbidity is common so additional work-up/screening is required...
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