Delirium alcohol

Organic, e.g. head injury, delirium, alcohol withdrawal... 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Cessation of prolonged heavy alcohol abuse may be followed by alcohol withdrawal or life-threatening alcohol withdrawal delirium. Typical withdrawal symptoms are autonomic hyperactivity, increased hand tremor, insomnia and anxiety, and are treated with benzodizepines and thiamine. Alcoholism is the most common cause of thiamine deficiency and can lead in its extreme form to the Wernicke s syndrome that can be effectively treated by high doses of thiamine. 

The energy substrates are contraindicated in patients with hypersensitivity to any component of the solution. Dextrose solutions are contraindicated in patients with diabetic coma with excessively high blood sugar. Concentrated dextrose solutions are contraindicated in patients with increased intracranial pressure, delirium tremens (if patient is dehydrated), hepatic coma, or glucose-galactose malabsorption syndrome Alcohol dextrose solutions are contraindicated in patients with epilepsy, urinary tract infections, alcoholism, and diabetic coma... 

Hernandez M, McDaniel CH, Costanza CD, et al GHB-induced delirium a case report and review of the literature of gamma hydroxybutyric acid. Am J Drug Alcohol Abuse 24 179-183, 1998... 

The oldest anti-anxiety agent is undoubtedly alcohol and it is certain that this drug is still routinely self-administered for this purpose. Towards the end of the eighteenth century, bromide salts were used to relieve conditions akin to anxiety despite the risk of a characteristic toxic delirium, known as bromism . Alternative treatments, such as paraldehyde and chloral hydrate, were also widely used but these too had adverse effects the former can cause psychosis but the latter is still used as a sedative and anaesthetic agent. 

Gorwood, P., Limosin, F., Batel, P., Hamon, M., Ades, J., and Boni, C., The A9 allele of the dopamine transporter gene is associated with delirium tremens and alcohol-withdrawal seizure, Biol. Psychiatry, 53, 85, 2003. 

Delirium tremens The most severe sign of alcohol withdrawal characterised by hallucinations and paranoia ( delirium ), marked tremor and convulsions ( tremens ). 

Secobarbital exhibits the same pharmacologic properties as other members of the barbiturate class. Most nonmedical use is with short-acting barbiturates, such as secobarbital. Although there may be considerable tolerance to the sedative and intoxicating effects of the drug, the lethal dose is not much greater in addicted than in normal persons. Tolerance does not develop to the respiratory effect. The combination of alcohol and barbiturates may lead to fatalities because of their combined respiratory depressive effects. Similar outcomes may occur with the benzodiazepines. Severe withdrawal symptoms in epileptic patients may include grand mal seizures and delirium. 

Information about prescription drag use alcohol or other substance use family medical history and history of trauma, depression, or head injury should be obtained. It is important to rule out medication use as a contributor or cause of symptoms (e.g., anticholinergics, sedatives, hypnotics, opioids, antipsychotics, and anticonvulsants) as contributors to dementia symptoms. Other medications may contribute to delirium, e.g.,... 

Signs and symptoms of alcohol intoxication are slurred speech, ataxia, sedation, nystagmus, unconsciousness, nausea, vomiting, hallucinations, delirium, and seizures. Signs and symptoms of alcohol withdrawal are tachycardia, diaphoresis, and hyperthermia. 

Signs and symptoms of BZ withdrawal are similar to those of alcohol withdrawal, including muscle pain, anxiety, restlessness, confusion, irritability, hallucinations, delirium, seizures, and cardiovascular collapse. Withdrawal from short-acting BZs (e.g., oxazepam, lorazepani, alprazolam) has an onset within 12 to 24 hours of the last dose. Diazepam, chlordiazep-oxide, and clorazepate have elimination half-lives (or active metabolites with elimination half-lives) of 24 to greater than 100 hours. So, withdrawal may be delayed for several days after their discontinuation. 

Symptoms of withdrawal include depression, altered mental status, drug craving, dyssomnia, and fatigue. Duration of withdrawal from methamphetamine ranges from 3 to 24 days, but these individuals are usually not in acute distress. Occurrence of delirium suggests withdrawal from another drug (e.g., alcohol). 

Alcohol Polyuria, frequency, urgency, sedation, delirium... 

It is important to be aware of possible adverse drug withdrawal events (ADWE). These events may be caused by physiological withdrawal reaction, but it is also possible that the underlying disease is worsened. An example of ADWE is delirium or seizures that may occur after abrupt discontinuing of benzodiazepines or alcohol. 

Delirium tremens (the D.T.s ) resulting from alcohol withdrawal is slightly different in that it is usually preceded by the shakes, convulsions and occasionally by alcoholic hallucinosis - characterized by accusatory auditory hallucinations. As observed 60 years ago by Maurice Victor, an expert on alcohol problems, delirium tremens usually does not appear until day 3 or 4 following abrupt withdrawal from alcohol. The patient is generally malnourished and grossly deficient in vitamin Bj (thiamine) as the result of a diet consisting of little but alcohol. This deficiency ftirther compromises mental function. 

Side effects of benzodiazepines include drowsiness and reduced respiratory function. In patients who are severely medically ill, especially those with lung disease, this side effect can be problematic. However, benzodiazepines are much safer in this regard than their predecessors, the barbiturates, and untreated delirium tremens, the most severe form of alcohol withdrawal, can be fatal. 

Although many physicians routinely use benzodiazepines to treat combative, delirious patients, this is not recommended. First, benzodiazepines can cloud consciousness and actually worsen the confusion of delirium. Second, benzodiazepines can worsen the breathing problems of patients with pneumonia or emphysema, two common causes of delirium. The lone exception is a delirium that is caused by alcohol or benzodiazepine withdrawal. A benzodiazepine MUST be used for alcohol... 

Qomethiazole can also be effective for controlling status epilepticus, but is used mainly to treat agitated states, especially alcoholic delirium tremens and associated seizures. 

Intoxication results in a characteristic intense, throbbing headache, presumably due to cerebral vasodilation, often associated with dizziness and nausea and occasionally with vomiting and abdominal pain. More severe exposure also causes hypotension, flushing, palpitation, low levels of methemoglobinemia, delirium, and depression of the central nervous system. Aggravation of these symptoms after alcohol ingestion has been observed. On repeated exposure, a tolerance to headache develops but is usually lost after a few days without exposure. At times, persistent tachycardia, diastolic hypertension, and reduced pulse pressure have been observed. On rare occasions, a worker may have an attack of angina pectoris a few days after cessation of repeated exposures, a manifestation of cardiac ischemia. Sudden death due to unheralded cardiac arrest has also been reported under these circumstances. ... 

IR concentrated oral solution and tablets/suppositories - Respiratory insufficiency or depression severe CNS depression attack of bronchial asthma heart failure secondary to chronic lung disease cardiac arrhythmias increased intracranial or CSF pressure head injuries brain tumor acute alcoholism delirium tremens convulsive disorders after biliary tract surgery suspected surgical abdomen surgical anastomosis concomitantly with MAOIs or within 14 days of such treatment paralytic ileus. 

Acute abdominal conditions Narcotics may obscure diagnosis or clinical course. Do not give SR morphine to patients with Gl obstruction, particularly paralytic ileus, as there is a risk of the product remaining in the stomach for an extended period and the subsequent release of a bolus of morphine when normal gut motility is restored. Special risk patients Exercise caution in elderly and debilitated patients and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Also exercise caution in patients sensitive to CNS depressants, including those with cardiovascular disease myxedema convulsive disorders increased ocular pressure acute alcoholism delirium tremens cerebral arteriosclerosis ulcerative... 

Use with caution in the foiiowing Elderly or debilitated severe impairment of hepatic, pulmonary or renal function myxedema or hypothyroidism adrenal cortical insufficiency CNS depression or coma toxic psychoses prostatic hypertrophy or urethral stricture acute alcoholism delirium tremens or kyphoscoliosis. Naloxone may not be effective in reversing respiratory depression. 

Acute alcohol withdrawal For the symptomatic relief of acute alcohol withdrawal (clorazepate, chlordiazepoxide, oxazepam) may be useful in symptomatic relief of acute agitation, tremor, impending or acute delirium, tremens, and hallucinosis (diazepam). 

IM only For the acutely disturbed or hysterical patient the acute or chronic alcoholic with anxiety withdrawal symptoms or delirium tremens allay anxiety adjunctive... 

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