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Delirium tremens

From Wikipedia
Delirium tremens
type of disease, signs den symptoms
Subclass ofdelirium, alcoholic hallucinosis Edit
Has causeSmoking, alcohol and drugs Edit
Health specialtypsychiatry Edit
Symptoms and signsagrypnia excitata Edit
ICD-9-CM291.0 Edit
ICPC 2 IDP15 Edit

Delirium tremens (DTs; lit. 'mental disturbance with shaking') be a rapid onset of confusion wey withdrawal from alcohol cause.[1] DT typically dey occur 48–72 hours after de last use of alcohol den symptoms dey last 1–8 days.[1][2] Typical symptoms dey include nightmares, confusion, disorientation, heavy sweating, elevated heart rate, den elevated blood pressure.[2][3] Visual, auditory, den tactile hallucinations sanso be common.[1] DT fi be fatal especially widout treatment. Occasionally, a very high body temperature anaa seizures (dem colloquially know as "rum fits")[4][5] fi result in death.[1] Oda causes of death dey include respiratory failure den cardiac arrhythmias.[1]

Delirium tremens typically dey occur only insyd people plus a high intake of alcohol for prolonged periods of time, wey sharply reduced intake follow.[6] A similar syndrome fi occur plus benzodiazepine den barbiturate withdrawal, however de term delirium tremens be reserved for alcohol withdrawal. Insyd a person plus delirium tremens, e be important to rule out oda associated problems such as electrolyte abnormalities, pancreatitis, den alcoholic hepatitis.[1]

Prevention be by treating withdrawal symptoms using similarly acting compounds to taper off de use of de precipitating substance insyd a controlled fashion.[1] If delirium tremens dey occur, aggressive treatment plus benzodiazepines dey improve outcomes.[1] Treatment insyd a quiet intensive care unit plus sufficient light often be recommended to re-orient de patient.[1] Benzodiazepines be de medication of choice plus short acting compounds wey dey include lorazepam den oxazepam commonly be used, wich bypass de liver.[6] Dese medications typically be given in response to de patient ein symptoms, rather dan at regular intervals.[7] Nonbenzodiazepines be often used as adjuncts to manage de sleep disturbance dem associate plus condition. De antipsychotic haloperidol sanso fi be used[1] in order to combat de overactivity den possible excitotoxicity wey de withdrawal from a GABA-ergic substance cause. Antipsychotics, however, no be used alone as dem fi increase de risk of seizure.[8] Thiamine (vitamin B1) be recommended to be given intramuscularly,[1] secof long-term high alcohol intake den de associated nutritional deficit dey lead to a thiamine deficiency, wich sam times no fi be rectified by supplement pills alone.

Mortality widout treatment historically be between 15% den 40%.[9] Plus improvements insyd treatment over de years, currently death dey occur insyd about 1% to 4% of cases.[10]

About half of people plus alcoholism go develop withdrawal symptoms upon reducing dema use.[10] Of dese, 3% to 5% dey develop DTs anaa dem get seizures.[10]

De name delirium tremens first be used insyd 1813; however, de symptoms be well described since de 1700s.[11] De word "delirium" be Latin for "going off de furrow", a plowing metaphor give disordered thinking.[9] E sanso be called de shaking frenzy den Saunders-Sutton syndrome.[9] Der be numerous nickies give de condition, wey dey include "de DTs" den "seeing pink elephants".

References

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  1. 1 2 3 4 5 6 7 8 9 10 11 Schuckit, MA (November 27, 2014). "Recognition and management of withdrawal delirium (delirium tremens)". The New England Journal of Medicine. 371 (22): 2109–13. doi:10.1056/NEJMra1407298. PMID 25427113. S2CID 205116954.
  2. 1 2 Kaye, Alan D; Staser, Amanda N; Mccollins, Tiombee S; Zheng, Jackson; Berry, Fouad A; Burroughs, Caroline R; Heisler, Michael; Mouhaffel, Aya; Ahmadzadeh, Shahab; Kaye, Adam M; Shekoohi, Sahar; Varrassi, Giustino (April 4, 2024). "Delirium Tremens: A Review of Clinical Studies". Cureus (in English). 16 (4) e57601. doi:10.7759/cureus.57601. ISSN 2168-8184. PMC 11069634. PMID 38707114.
  3. ↑ Healy, David (December 3, 2008). Psychiatric Drugs Explained. Elsevier Health Sciences. p. 237. ISBN 978-0-7020-2997-4. Archived from the original on September 8, 2017.
  4. ↑ "rum fits". Medical dictionary. Farlex, Inc. Retrieved November 22, 2022.
  5. ↑ Rhinehart, John W. (1961). "Factors determining "rum fits"". American Journal of Psychiatry (in English). 118 (3): 251–252. doi:10.1176/ajp.118.3.251. ISSN 0002-953X. PMID 13741146. Retrieved February 1, 2023.
  6. 1 2 Stern, TA; Gross, AF; Stern, TW; Nejad, SH; Maldonado, JR (2010). "Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles"". Primary Care Companion to the Journal of Clinical Psychiatry. 12 (3). doi:10.4088/PCC.10r00991ecr. PMC 2947546. PMID 20944765.
  7. ↑ Haber, Paul S. (January 16, 2025). Ropper, Allan H. (ed.). "Identification and Treatment of Alcohol Use Disorder". New England Journal of Medicine (in English). 392 (3): 258–266. doi:10.1056/NEJMra2306511. ISSN 0028-4793. PMID 39813644.
  8. ↑ Alvanzo, Anika; Kleinschmidt, Kurt; Kmiec, Julie A.; et al. (23 January 2020). Clinical Practice Guideline on Alcohol Withdrawal Management (PDF) (Report). American Society of Addiction Medicine.
  9. 1 2 3 Blom, Jan Dirk (2010). A dictionary of hallucinations (. ed.). New York: Springer. p. 136. ISBN 978-1-4419-1223-7. Archived from the original on March 4, 2016.
  10. 1 2 3 Schuckit, MA (November 27, 2014). "Recognition and management of withdrawal delirium (delirium tremens)". The New England Journal of Medicine. 371 (22): 2109–13. doi:10.1056/NEJMra1407298. PMID 25427113. S2CID 205116954.
  11. ↑ Stern, TA; Gross, AF; Stern, TW; Nejad, SH; Maldonado, JR (2010). "Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles"". Primary Care Companion to the Journal of Clinical Psychiatry. 12 (3). doi:10.4088/PCC.10r00991ecr. PMC 2947546. PMID 20944765.
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