Delirium tremens management

The main drugs in this section are the barbiturates which can be considered as dry drink , and the withdrawal effects are very similar to the withdrawal from alcohol. Full-blown delirium tremens and epileptic fits can be observed and will need, usually, in-patient management and close supervision and sedation. 

The treatment of patients during a delirium tremens episode includes the intravenous administration of another CNS depressant (usually diazepam) during the acute phase, followed by the oral administration of chlordiazepoxide or oxazepam. In addition, other medications and dietary management may become essential. 

The functional capacity of the brain is impaired. Irreversible damage may manifest in a measurable fallout of neuronal cell bodies. Often delirium tremens develops (usually triggered by alcohol withdrawal), which can be managed with intensive therapy (clomethiazole, haloperidol, among others). In addition, alcoholic hallucinations and Wernicke-Korsakow syndrome occur. All of these are desolate states. 

The patient is experiencing symptoms of the withdrawal syndrome from physical dependency on ethanol. Since seizures are possible, it would not be appropriate to attempt sedation with a phenothiazine such as chlorpromazine. Thiamine is usually administered to counteract the symptoms of Wernicke-Korsakoff syndrome but will not alleviate withdrawal symptoms. Neither buspirone nor naltrexone has value in the immediate management of alcohol withdrawal states. The patient is indeed suffering from delirium tremens. The answer is (B). 

Chapter 77 Delirium tremens Preparation Assessment Management What If... ... 

Table 74.2 RT options in fit adults tsee What if... for elderly/l,D/fraill Table 74.3 RT in elderly/l,D/frail patients Table 74.4 Managing aggression on psychiatric wards/CMHTs Chapter 77 Delirium tremens...

Some problems should never be managed in psychiatric units - and delirium tremens (DTs) is one of them (Box 77.1). Mortality rates are 5-35%, but higher without treatment or with comorbid physical illness. Consider Dlls whenever assessing a recent-onset (<1 week) delirium, especially where alcohol intake may have been suddenly stopped or reduced, e.g. by hospital admission. 

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