Delirium tremens

Paraldehyde, a miscellaneous sedative and hypnotic, may be used to treat delirium tremens and other psychiatric conditions. In addition, some barbiturates are used as anticonvulsants (see Chap. 28). 

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... 

Favazza AR, Martin P Chemotherapy of delirium tremens a survey of physicians preferences. Am J Psychiatry 131 1031—1033, 1974... 

The onset of GHB withdrawal symptoms typically begins 1—5 hours after the last dose initial symptoms include anxiety, tremor, tachycardia, nausea, and insomnia (Table 7—1). Untreated, the symptoms may progress within 24 hours to a more severe pattern that is similar to delirium tremens, with dys-... 

Uni 1ke other drugs of abuse, the diagnosis of PCP intoxication is often difficult because of the wide spectrum of clinical findings that occurs with this drug. PCP toxicity sometimes can be mistaken for delirium tremens, acute psychiatric illness, sedative/ hypnotic overdosage, amphetamine intoxication, or sedative/ hypnotic withdrawal syndromes. 

A score of more than 15 corresponds to severe withdrawal and at increased risk of seizures and delirium tremens... 

This regimen is useful in patients at high risk of major withdrawal or history of withdrawal seizures or delirium tremens... 

This is the most commonly observed syndrome, and as the name denotes, is not complicated by seizures, delirium tremens (DTs),... 

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 ). 

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. 

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

Other indications. Acutely, there is sedation with anxiolysis after neurolep-tization has been started. This effect can be utilized for psychosomatic uncoupling in disorders with a prominent psychogenic component neuroleptanalgesia (p. 216) by means of the buty-rophenone droperidol in combination with an opioid tranquilization of overexcited, agitated patients treatment of delirium tremens with haloperidol as well as the control of mania (see p. 234). 

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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