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Monday, May 22, 2017

DELIRIUM TREMENS

DELIRIUM TREMENS

1. Is an alcohol withdrawal syndrome which is a neurological emergency and outcomes depend on successful early treatment; with treatment, mortality is 1-5% and without treatment, it's 20%.

2. Symptoms include delirium, hyperpyrexia, hallucinations, sympathetic overactivity, tremulousness etc

3. CBC, urine/serum toxicology screen, septic screen, heavy metal screen, ABG, LP to rule out CNS infections, CT brain to rule out bleed, ECG and EEG, Serum Thiamine/ Folate levels are important investigations

4. Fixed dose benzodiazepine regimens are the main stay of treatment e.g. Lorazepam 2 mg iv/im Q6H for 4 doses followed by 1 mg iv/im Q6H for 8 doses; taper by 50% every day, after 48 hours). Beta blockers to control adrenergic over activity (e.g. Atenelol 25-100 mg OD to BD titrated to heart rate. Thiamine 1 mg iv OD for 3 days ( especially prior to glucose administration. to prevent Wernicke's encephalopathy) , Folic acid 1 mg po daily 

5. Watch for arrhythmias, electrolyte abnormalities, aspiration pneumonia, sepsis, dehydration 

6. Care in high dependency unit, in a well lit room

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