https://www.wikidoc.org/api.php?action=feedcontributions&user=Zehra+Malik&feedformat=atomwikidoc - User contributions [en]2024-03-28T13:46:51ZUser contributionsMediaWiki 1.40.0https://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735138Delirium tremens overview2023-08-14T23:36:27Z<p>Zehra Malik: /* Other Imaging Findings */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
There are no other [[imaging]] findings associated with delirium tremens.<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
There is no surgical intervention for delirium tremens.<br />
<br />
===Primary Prevention===<br />
<br />
There are no established measures for the [[primary prevention]] of delirium tremens other than to avoid or reduce the use of [[alcohol]].<br />
<br />
===Secondary Prevention===<br />
Effective measures for the [[secondary prevention]] of delirium tremens include early detection of [[symptoms]], prompt [[treatment]], [[CAGE]] assessment, and proper [[counseling]] to reduce [[alcohol]] consumption.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_other_imaging_findings&diff=1735137Delirium tremens other imaging findings2023-08-14T23:36:05Z<p>Zehra Malik: /* Other Imaging Findings */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
<br />
{{CMG}}; {{AE}} {{ZMalik}}<br />
<br />
==Overview==<br />
There are no other [[imaging]] findings associated with delirium tremens.<br />
<br />
==Other Imaging Findings==<br />
There are no other [[imaging]] findings associated with delirium tremens.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_other_imaging_findings&diff=1735136Delirium tremens other imaging findings2023-08-14T23:35:56Z<p>Zehra Malik: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
<br />
{{CMG}}; {{AE}} {{ZMalik}}<br />
<br />
==Overview==<br />
There are no other [[imaging]] findings associated with delirium tremens.<br />
<br />
==Other Imaging Findings==<br />
There are no other imaging findings associated with delirium tremens.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_other_imaging_findings&diff=1735135Delirium tremens other imaging findings2023-08-14T23:35:43Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
<br />
{{CMG}}; {{AE}} {{ZMalik}}<br />
<br />
==Overview==<br />
There are no other imaging findings associated with delirium tremens.<br />
<br />
==Other Imaging Findings==<br />
There are no other imaging findings associated with delirium tremens.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_other_imaging_findings&diff=1735134Delirium tremens other imaging findings2023-08-14T23:35:35Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
<br />
{{CMG}}; {{AE}} {{ZMalik}}<br />
<br />
==Overview==<br />
There are no other imaging findings associated with delirium tremens.<br />
<br />
<br />
==Other Imaging Findings==<br />
There are no other imaging findings associated with delirium tremens.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735133Delirium tremens overview2023-08-14T23:30:08Z<p>Zehra Malik: /* Secondary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
There is no surgical intervention for delirium tremens.<br />
<br />
===Primary Prevention===<br />
<br />
There are no established measures for the [[primary prevention]] of delirium tremens other than to avoid or reduce the use of [[alcohol]].<br />
<br />
===Secondary Prevention===<br />
Effective measures for the [[secondary prevention]] of delirium tremens include early detection of [[symptoms]], prompt [[treatment]], [[CAGE]] assessment, and proper [[counseling]] to reduce [[alcohol]] consumption.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_secondary_prevention&diff=1735132Delirium tremens secondary prevention2023-08-14T23:29:50Z<p>Zehra Malik: /* Secondary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
<br />
==Overview==<br />
Effective measures for the [[secondary prevention]] of delirium tremens include early detection of [[symptoms]], prompt [[treatment]], [[CAGE]] assessment, and proper [[counseling]] to reduce [[alcohol]] consumption.<br />
<br />
==Secondary Prevention==<br />
Effective measures for the [[secondary prevention]] of delirium tremens include:<br />
*Early detection of [[symptoms]]<br />
*Prompt [[treatment]]<br />
*[[CAGE]] assessment on annual check-ups <br />
*Proper [[counseling]] to reduce [[alcohol]] consumption.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_secondary_prevention&diff=1735131Delirium tremens secondary prevention2023-08-14T23:29:37Z<p>Zehra Malik: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
<br />
==Overview==<br />
Effective measures for the [[secondary prevention]] of delirium tremens include early detection of [[symptoms]], prompt [[treatment]], [[CAGE]] assessment, and proper [[counseling]] to reduce [[alcohol]] consumption.<br />
<br />
==Secondary Prevention==<br />
Effective measures for the [[secondary prevention]] of delirium tremens include:<br />
*Early detection of [[symptoms]]<br />
*Prompt treatment<br />
*[[CAGE]] assessment on annual check-ups <br />
*Proper counseling to reduce [[alcohol]] consumption.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_secondary_prevention&diff=1735130Delirium tremens secondary prevention2023-08-14T23:29:14Z<p>Zehra Malik: /* Secondary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
<br />
==Overview==<br />
Effective measures for the [[secondary prevention]] of delirium tremens include early detection of [[symptoms]], prompt treatment, [[CAGE]] assessment, and proper counseling to reduce [[alcohol]] consumption.<br />
<br />
==Secondary Prevention==<br />
Effective measures for the [[secondary prevention]] of delirium tremens include:<br />
*Early detection of [[symptoms]]<br />
*Prompt treatment<br />
*[[CAGE]] assessment on annual check-ups <br />
*Proper counseling to reduce [[alcohol]] consumption.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_secondary_prevention&diff=1735129Delirium tremens secondary prevention2023-08-14T23:29:07Z<p>Zehra Malik: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
<br />
==Overview==<br />
Effective measures for the [[secondary prevention]] of delirium tremens include early detection of [[symptoms]], prompt treatment, [[CAGE]] assessment, and proper counseling to reduce [[alcohol]] consumption.<br />
<br />
==Secondary Prevention==<br />
Effective measures for the secondary prevention of delirium tremens include:<br />
*Early detection of [[symptoms]]<br />
*Prompt treatment<br />
*[[CAGE]] assessment on annual check-ups <br />
*Proper counseling to reduce [[alcohol]] consumption. <br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735128Delirium tremens overview2023-08-14T23:28:54Z<p>Zehra Malik: /* Secondary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
There is no surgical intervention for delirium tremens.<br />
<br />
===Primary Prevention===<br />
<br />
There are no established measures for the [[primary prevention]] of delirium tremens other than to avoid or reduce the use of [[alcohol]].<br />
<br />
===Secondary Prevention===<br />
Effective measures for the [[secondary prevention]] of delirium tremens include early detection of [[symptoms]], prompt treatment, [[CAGE]] assessment, and proper counseling to reduce [[alcohol]] consumption.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735127Delirium tremens overview2023-08-14T23:28:40Z<p>Zehra Malik: /* Secondary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
There is no surgical intervention for delirium tremens.<br />
<br />
===Primary Prevention===<br />
<br />
There are no established measures for the [[primary prevention]] of delirium tremens other than to avoid or reduce the use of [[alcohol]].<br />
<br />
===Secondary Prevention===<br />
Effective measures for the secondary prevention of delirium tremens include early detection of [[symptoms]], prompt treatment, [[CAGE]] assessment, and proper counseling to reduce [[alcohol]] consumption.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_secondary_prevention&diff=1735126Delirium tremens secondary prevention2023-08-14T23:28:29Z<p>Zehra Malik: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
<br />
==Overview==<br />
Effective measures for the secondary prevention of delirium tremens include early detection of [[symptoms]], prompt treatment, [[CAGE]] assessment, and proper counseling to reduce [[alcohol]] consumption.<br />
<br />
==Secondary Prevention==<br />
Effective measures for the secondary prevention of delirium tremens include:<br />
*Early detection of [[symptoms]]<br />
*Prompt treatment<br />
*[[CAGE]] assessment on annual check-ups <br />
*Proper counseling to reduce [[alcohol]] consumption. <br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_secondary_prevention&diff=1735125Delirium tremens secondary prevention2023-08-14T23:28:16Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
<br />
==Overview==<br />
Effective measures for the secondary prevention of delirium tremens include early detection of [[symptoms]], prompt treatment, [[CAGE]] assessment, and proper counseling to reduce [[alcohol]] consumption. <br />
<br />
==Secondary Prevention==<br />
Effective measures for the secondary prevention of delirium tremens include:<br />
*Early detection of [[symptoms]]<br />
*Prompt treatment<br />
*[[CAGE]] assessment on annual check-ups <br />
*Proper counseling to reduce [[alcohol]] consumption. <br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735124Delirium tremens overview2023-08-14T23:23:47Z<p>Zehra Malik: /* Surgery */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
There is no surgical intervention for delirium tremens.<br />
<br />
===Primary Prevention===<br />
<br />
There are no established measures for the [[primary prevention]] of delirium tremens other than to avoid or reduce the use of [[alcohol]].<br />
<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735123Delirium tremens overview2023-08-14T23:21:59Z<p>Zehra Malik: /* Primary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
<br />
===Primary Prevention===<br />
<br />
There are no established measures for the [[primary prevention]] of delirium tremens other than to avoid or reduce the use of [[alcohol]].<br />
<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_primary_prevention&diff=1735122Delirium tremens primary prevention2023-08-14T23:21:43Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
==Overview==<br />
There are no established measures for the [[primary prevention]] of delirium tremens other than to avoid or reduce the use of [[alcohol]]. <br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_secondary_prevention&diff=1735121Delirium tremens secondary prevention2023-08-14T23:18:55Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_primary_prevention&diff=1735120Delirium tremens primary prevention2023-08-14T23:16:11Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}}{{AE}}{{ZMalik}}<br />
==Overview==<br />
Avoid or reduce the use of [[alcohol]]. Get prompt medical treatment for symptoms of alcohol withdrawal.<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735094Delirium tremens overview2023-08-10T23:54:40Z<p>Zehra Malik: /* Medical Therapy */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
<br />
===Primary Prevention===<br />
<br />
Avoid or reduce the use of [[alcohol]]. Get prompt medical treatment for symptoms of alcohol withdrawal.<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735093Delirium tremens medical therapy2023-08-10T23:54:24Z<p>Zehra Malik: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].<br />
<br />
==Medical Therapy==<br />
*Supportive care and sedation are the mainstay of [[treatment]] for delirium tremens. <br />
*For [[sedation]], [[benzodiazepines]] are the first choice. <br />
*Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable [[serum]] level.<br />
*There are three approved techniques for the use of [[benzodiazepines]] in these [[patients]] to achieve an optimum level of [[sedation]] or to lower the CIWA score to <8: The techniques are: <br />
**Front loading (Most preferred)<br />
***5 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***10 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***20 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***5-20 mg IV per hour. <br />
**This regimen is followed until the goal of light sedation of CIWA score of <8 is achieved.<br />
**Symptom-triggered<br />
***10–20 mg IV [[diazepam]] administered every 1–4 hours until the [[treatment]] goal is met. <br />
***If using [[lorazepam]], then 4 mg IV should be administered every 10 minutes. <br />
**Fixed-dose (Least preferred)<br />
***Used only for [[alcohol withdrawal syndrome]] in an [[outpatient]] setting.<br />
<br />
<br />
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
<br />
<br />
<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735092Delirium tremens medical therapy2023-08-10T23:53:44Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
The mainstay of delirium tremens treatment is supportive care and sedatives. Benzodiazepines are the initial choice for sedation. To establish a consistent serum level, long-acting benzodiazepines such as diazepam and chlordiazepoxide are favored over short-acting benzodiazepines. <br />
==Medical Therapy==<br />
*Supportive care and sedation are the mainstay of [[treatment]] for delirium tremens. <br />
*For [[sedation]], [[benzodiazepines]] are the first choice. <br />
*Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable [[serum]] level.<br />
*There are three approved techniques for the use of [[benzodiazepines]] in these [[patients]] to achieve an optimum level of [[sedation]] or to lower the CIWA score to <8: The techniques are: <br />
**Front loading (Most preferred)<br />
***5 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***10 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***20 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***5-20 mg IV per hour. <br />
**This regimen is followed until the goal of light sedation of CIWA score of <8 is achieved.<br />
**Symptom-triggered<br />
***10–20 mg IV [[diazepam]] administered every 1–4 hours until the [[treatment]] goal is met. <br />
***If using [[lorazepam]], then 4 mg IV should be administered every 10 minutes. <br />
**Fixed-dose (Least preferred)<br />
***Used only for [[alcohol withdrawal syndrome]] in an [[outpatient]] setting.<br />
<br />
<br />
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
<br />
<br />
<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735091Delirium tremens medical therapy2023-08-10T23:49:05Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
The mainstay of [[treatment]] for delirium tremens is supportive care and sedation. For [[sedation]], [[benzodiazepines]] are the first choice. Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable [[serum]] level.<br />
==Medical Therapy==<br />
*The mainstay of [[treatment]] for delirium tremens is supportive care and sedation. <br />
*For [[sedation]], [[benzodiazepines]] are the first choice. <br />
*Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable [[serum]] level.<br />
*There are three approved techniques for the use of [[benzodiazepines]] in these [[patients]] to achieve an optimum level of [[sedation]] or to lower the CIWA score to <8: The techniques are: <br />
**Front loading (Most preferred)<br />
***5 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***10 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***20 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***5-20 mg IV per hour. <br />
**This regimen is followed until the goal of light sedation of CIWA score of <8 is achieved.<br />
**Symptom-triggered<br />
***10–20 mg IV [[diazepam]] administered every 1–4 hours until the [[treatment]] goal is met. <br />
***If using [[lorazepam]], then 4 mg IV should be administered every 10 minutes. <br />
**Fixed-dose (Least preferred)<br />
***Used only for [[alcohol withdrawal syndrome]] in an [[outpatient]] setting.<br />
<br />
<br />
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
<br />
<br />
<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735090Delirium tremens medical therapy2023-08-10T23:47:08Z<p>Zehra Malik: /* Medical Therapy */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
==Medical Therapy==<br />
*The mainstay of [[treatment]] for delirium tremens is supportive care and sedation. <br />
*For [[sedation]], [[benzodiazepines]] are the first choice. <br />
*Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable [[serum]] level.<br />
*There are three approved techniques for the use of [[benzodiazepines]] in these [[patients]] to achieve an optimum level of [[sedation]] or to lower the CIWA score to <8: The techniques are: <br />
**Front loading (Most preferred)<br />
***5 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***10 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***20 mg IV [[Diazepam]] administered twice with interval of 10 mins<br />
***5-20 mg IV per hour. <br />
**This regimen is followed until the goal of light sedation of CIWA score of <8 is achieved.<br />
**Symptom-triggered<br />
***10–20 mg IV [[diazepam]] administered every 1–4 hours until the [[treatment]] goal is met. <br />
***If using [[lorazepam]], then 4 mg IV should be administered every 10 minutes. <br />
**Fixed-dose (Least preferred)<br />
***Used only for [[alcohol withdrawal syndrome]] in an [[outpatient]] setting.<br />
<br />
<br />
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
<br />
<br />
<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735089Delirium tremens medical therapy2023-08-10T15:56:43Z<p>Zehra Malik: /* Medical Therapy */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
==Medical Therapy==<br />
*The mainstay of treatment for delirium tremens is supportive care and sedation. <br />
*For sedation, [[benzodiazepines]] are the first choice. <br />
*Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable serum level.<br />
*There are three approved techniques for the use of [[benzodiazepines]] in these [[patients]] in order to achieve <br />
**Front loading (Most preferred)<br />
**Symptom-triggered<br />
**Fixed-dose (Least preferred)<br />
<br />
<br />
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
<br />
<br />
<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735088Delirium tremens medical therapy2023-08-10T15:54:14Z<p>Zehra Malik: /* Medical Therapy */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
==Medical Therapy==<br />
*The mainstay of treatment for delirium tremens is supportive care and sedation. <br />
*For sedation, [[benzodiazepines]] are the first choice. <br />
*Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable serum level.<br />
*There are three options for the [[treatment]] of delirium tremens, <br />
**Front loading (Most preferred)<br />
**Symptom-triggered<br />
**Fixed-dose (Least preferred)<br />
<br />
<br />
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
<br />
<br />
<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735087Delirium tremens medical therapy2023-08-10T15:51:57Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
==Medical Therapy==<br />
*The mainstay of treatment for delirium tremens is supportive care and sedation. <br />
*For sedation, [[benzodiazepines]] are the first choice. To achieve a stable serum level of [[benzodiazepine]], it is preferred to use long-acting [[drugs]] such as [[diazepam]] and [[chlordiazepoxide]] as compared to short-acting [[benzodiazepine]]. <br />
*There are three options for the [[treatment]] of delirium tremens, <br />
**Front loading (Most preferred)<br />
**Symptom-triggered<br />
**Fixed-dose (Least preferred)<br />
<br />
<br />
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
<br />
<br />
<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735086Delirium tremens medical therapy2023-08-10T15:49:39Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
<br />
The mainstay of treatment for delirium tremens is supportive care and sedation. For sedation, [[benzodiazepines]] are the first choice. To achieve a stable serum level of [[benzodiazepine]], it is preferred to use long-acting [[drugs]] such as [[diazepam]] and [[chlordiazepoxide]] as compared to [[short-acting benzodiazepine]]. There are three options for the [[treatment]] of delirium tremens, fixed-dose, symptom-triggered, and front loading. <br />
<br />
Contraindication: Incase of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. <br />
<br />
OR<br />
<br />
The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
<br />
OR<br />
<br />
[Therapy] is recommended among all patients who develop [disease name].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
<br />
OR<br />
<br />
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
<br />
OR<br />
<br />
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
<br />
==Medical Therapy==<br />
<br />
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. <br />
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
===Delirium tremens===<br />
REGIMES DOSES<br />
Front loading With diazepam: the aim is to achieve light sedation (patient still could be aroused with verbal stimulation) or to bring down CIWA-Ar <8<br />
5 mg IV → 5 mg IV (repeat after 10 min)<br />
10 mg IV → 10 mg IV (repeat after 10 min)<br />
20 mg IV after 10 min<br />
5–20 mg IV per hour<br />
[Dosing must be continued till the aim of light sedation or the CIWA-Ar score has been achieved]<br />
Symptom triggered With diazepam 10–20 mg IV every 1–4 h → repeat doses till CIWA-Ar score <8<br />
With lorazepam: 4 mg IV to be repeated every 10 min till either of the aims of front loading is achieved<br />
If severe delirium still persists even after 16 mg IV→ 8 mg IV bolus is to be administered<br />
Fixed dose Not to be used for DT; Only for outpatient management of alcohol withdrawal syndrome<br />
Open in a separate window<br />
CIWA-Ar: Clinical Institute Withdrawal Assessment-Alcohol (revised); IV: Intravenous.<br />
<br />
<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]<br />
<br />
==Medical Therapy==<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_medical_therapy&diff=1735082Delirium tremens medical therapy2023-08-10T15:34:42Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
<br />
OR<br />
<br />
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].<br />
<br />
OR<br />
<br />
The majority of cases of [disease name] are self-limited and require only supportive care.<br />
<br />
OR<br />
<br />
[Disease name] is a medical emergency and requires prompt treatment.<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is [therapy].<br />
<br />
OR<br />
<br />
The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
<br />
OR<br />
<br />
[Therapy] is recommended among all patients who develop [disease name].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
<br />
OR<br />
<br />
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
<br />
OR<br />
<br />
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
<br />
==Medical Therapy==<br />
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. <br />
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
===Disease Name===<br />
<br />
* '''1 Stage 1 - Name of stage'''<br />
** 1.1 '''Specific Organ system involved 1'''<br />
*** 1.1.1 '''Adult'''<br />
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' <br />
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days<br />
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days<br />
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days<br />
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 1.1.2 '''Pediatric'''<br />
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) <br />
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)<br />
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')<br />
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h(maximum, 100 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) <br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)<br />
** 1.2 '''Specific Organ system involved 2'''<br />
*** 1.2.1 '''Adult'''<br />
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h <br />
*** 1.2.2 '''Pediatric'''<br />
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)<br />
<br />
* 2 '''Stage 2 - Name of stage'''<br />
** 2.1 '''Specific Organ system involved 1 '''<br />
**: '''Note (1):''' <br />
**: '''Note (2)''': <br />
**: '''Note (3):''' <br />
*** 2.1.1 '''Adult'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days<br />
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days<br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days <br />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days <br />
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days <br />
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 2.1.2 '''Pediatric'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)<br />
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)<br />
***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''<br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)<br />
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)<br />
** 2.2 '<nowiki/>'''''Other Organ system involved 2''''''<br />
**: '''Note (1):''' <br />
**: '''Note (2)''': <br />
**: '''Note (3):''' <br />
*** 2.2.1 '''Adult'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days<br />
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days <br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days <br />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days <br />
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days <br />
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 2.2.2 '''Pediatric'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)<br />
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)<br />
***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) <br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)<br />
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]<br />
<br />
==Medical Therapy==<br />
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735069Delirium tremens overview2023-08-09T15:40:58Z<p>Zehra Malik: /* MRI */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
<br />
===Primary Prevention===<br />
<br />
Avoid or reduce the use of [[alcohol]]. Get prompt medical treatment for symptoms of alcohol withdrawal.<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_MRI&diff=1735068Delirium tremens MRI2023-08-09T15:40:47Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
==Overview==<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
==MRI==<br />
There are no [[MRI]] findings associated with delirium tremens. [[MRI]] can show signs of [[Wernicke's Encephalopathy]] in a patient with [[chronic]] [[alcohol]] abuse.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Needs content]]<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_CT&diff=1735067Delirium tremens CT2023-08-08T23:49:28Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
==CT Scan==<br />
A [[head]] [[CT scan]] may help identify the following:<br />
*Intracranial [[pathology]]<br />
*[[Head injury]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735066Delirium tremens overview2023-08-08T23:49:05Z<p>Zehra Malik: /* CT scan */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===MRI===<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
<br />
===Primary Prevention===<br />
<br />
Avoid or reduce the use of [[alcohol]]. Get prompt medical treatment for symptoms of alcohol withdrawal.<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_CT&diff=1735065Delirium tremens CT2023-08-08T23:48:43Z<p>Zehra Malik: /* CT Scan */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Overview==<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
==CT Scan==<br />
A [[head]] [[CT scan]] may help identify the following:<br />
*Intracranial [[pathology]]<br />
*[[Head injury]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_CT&diff=1735064Delirium tremens CT2023-08-08T23:48:29Z<p>Zehra Malik: /* CT Scan */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Overview==<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
==CT Scan==<br />
A head [[CT scan]] may help identify the following:<br />
*Intracranial [[pathology]]<br />
*[[Head injury]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_CT&diff=1735063Delirium tremens CT2023-08-08T23:48:11Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Overview==<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
==CT Scan==<br />
A head CT scan may help identify the following:<br />
*Intracranial pathology<br />
*Head injury <br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_CT&diff=1735062Delirium tremens CT2023-08-08T23:46:30Z<p>Zehra Malik: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Overview==<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic]] [[alcohol]] abuse.<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_CT&diff=1735061Delirium tremens CT2023-08-08T23:46:14Z<p>Zehra Malik: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Overview==<br />
A head [[CT scan]] should be performed to evaluate any [[intracranial]] [[pathology]] or to identify a [[head]] [[injury]] that may have triggered the [[tremors]] in a [[patient]] with a history of [[chronic alcohol abuse]].<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735060Delirium tremens physical examination2023-08-08T23:42:45Z<p>Zehra Malik: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Overview==<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
==Physical Examination==<br />
<br />
===Appearance of the Patient===<br />
The patient may present with [[confusion]], [[diaphoresis]], and [[agitation]].<br />
<br />
===Vital Signs===<br />
*[[Hyperthermia]]<br />
*[[Tachycardia]]<br />
*[[Hypertension]]<br />
*[[Tachypnea]]<br />
<br />
===Skin===<br />
[[Skin]] [[examinations]] of [[patients]] with delirium tremens include:<br />
*[[Diaphoresis]]<br />
*[[Jaundice]] <br />
<br />
===HEENT===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735059Delirium tremens overview2023-08-08T23:42:11Z<p>Zehra Malik: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens, patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A CT scan of the head should be performed to evaluate any intracranial pathology.<br />
===MRI===<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
<br />
===Primary Prevention===<br />
<br />
Avoid or reduce the use of [[alcohol]]. Get prompt medical treatment for symptoms of alcohol withdrawal.<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735058Delirium tremens overview2023-08-08T23:41:19Z<p>Zehra Malik: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
<br />
==Pathophysiology==<br />
<br />
==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
<br />
==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
<br />
==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
<br />
===Physical Examination===<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Although there are no physical findings diagnostic of delirium tremens but these patients may present with [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
<br />
===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
<br />
===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
<br />
===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
<br />
===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
<br />
===CT scan===<br />
A CT scan of the head should be performed to evaluate any intracranial pathology.<br />
===MRI===<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
<br />
<br />
==Treatment==<br />
<br />
===Medical Therapy===<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
<br />
===Primary Prevention===<br />
<br />
Avoid or reduce the use of [[alcohol]]. Get prompt medical treatment for symptoms of alcohol withdrawal.<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735057Delirium tremens physical examination2023-08-08T23:39:25Z<p>Zehra Malik: </p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{ZMalik}}<br />
==Physical Examination==<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Physical examination of patients with delirium tremens is usually remarkable for [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
===Appearance of the Patient===<br />
The patient may present with [[confusion]], [[diaphoresis]], and [[agitation]].<br />
<br />
===Vital Signs===<br />
*[[Hyperthermia]]<br />
*[[Tachycardia]]<br />
*[[Hypertension]]<br />
*[[Tachypnea]]<br />
<br />
===Skin===<br />
[[Skin]] [[examinations]] of [[patients]] with delirium tremens include:<br />
*[[Diaphoresis]]<br />
*[[Jaundice]] <br />
<br />
===HEENT===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735056Delirium tremens physical examination2023-08-08T23:39:04Z<p>Zehra Malik: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Physical Examination==<br />
Patients with delirium tremens usually appear [[diaphoretic]], confused and agitated. Physical examination of patients with delirium tremens is usually remarkable for [[fever]], [[tachycardia]], [[high blood pressure]], [[tachypnea]], [[altered mental status]], [[mydriasis]], [[positional nystagmus]], and [[tremor]].<br />
===Appearance of the Patient===<br />
The patient may present with [[confusion]], [[diaphoresis]], and [[agitation]].<br />
<br />
===Vital Signs===<br />
*[[Hyperthermia]]<br />
*[[Tachycardia]]<br />
*[[Hypertension]]<br />
*[[Tachypnea]]<br />
<br />
===Skin===<br />
[[Skin]] [[examinations]] of [[patients]] with delirium tremens include:<br />
*[[Diaphoresis]]<br />
*[[Jaundice]] <br />
<br />
===HEENT===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735055Delirium tremens physical examination2023-08-08T23:29:36Z<p>Zehra Malik: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Physical Examination==<br />
Delirium tremens is the most severe presentation of [[alcohol withdrawal]], and the [[patient]] may present with [[fever]], increased [[blood pressure]] and [[heart rate]], and [[hallucinations]].<br />
===Appearance of the Patient===<br />
The patient may present with [[confusion]], [[diaphoresis]], and [[agitation]].<br />
<br />
===Vital Signs===<br />
*[[Hyperthermia]]<br />
*[[Tachycardia]]<br />
*[[Hypertension]]<br />
*[[Tachypnea]]<br />
*<br />
<br />
===Eye===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735054Delirium tremens physical examination2023-08-08T23:26:15Z<p>Zehra Malik: /* Appearance of the Patient */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Physical Examination==<br />
Delirium tremens is the most severe presentation of [[alcohol withdrawal]], and the [[patient]] may present with [[fever]], increased [[blood pressure]] and [[heart rate]], and [[hallucinations]].<br />
===Appearance of the Patient===<br />
The patient may present with [[confusion]], [[diaphoresis]], and [[agitation]].<br />
<br />
===Vital Signs===<br />
====Temperature====<br />
* [[Hyperthermia]]<br />
====Pulse====<br />
* [[Tachycardia]]<br />
====Blood Pressure====<br />
* [[Hypertension]]<br />
====Respiratory Rate====<br />
* [[Tachypnea]]<br />
<br />
===Eye===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735053Delirium tremens physical examination2023-08-08T23:25:26Z<p>Zehra Malik: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Physical Examination==<br />
Delirium tremens is the most severe presentation of [[alcohol withdrawal]], and the [[patient]] may present with [[fever]], increased [[blood pressure]] and [[heart rate]], and [[hallucinations]].<br />
===Appearance of the Patient===<br />
<br />
===Vital Signs===<br />
====Temperature====<br />
* [[Hyperthermia]]<br />
====Pulse====<br />
* [[Tachycardia]]<br />
====Blood Pressure====<br />
* [[Hypertension]]<br />
====Respiratory Rate====<br />
* [[Tachypnea]]<br />
<br />
===Eye===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735052Delirium tremens physical examination2023-08-08T23:25:18Z<p>Zehra Malik: /* Appearance of the Patient */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Physical Examination==<br />
===Appearance of the Patient===<br />
<br />
===Vital Signs===<br />
====Temperature====<br />
* [[Hyperthermia]]<br />
====Pulse====<br />
* [[Tachycardia]]<br />
====Blood Pressure====<br />
* [[Hypertension]]<br />
====Respiratory Rate====<br />
* [[Tachypnea]]<br />
<br />
===Eye===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_physical_examination&diff=1735051Delirium tremens physical examination2023-08-08T23:25:02Z<p>Zehra Malik: /* Appearance of the Patient */</p>
<hr />
<div>__NOTOC__<br />
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.<br />
<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}}<br />
==Physical Examination==<br />
===Appearance of the Patient===<br />
Delirium tremens is the most severe presentation of [[alcohol withdrawal]], and the [[patient]] may present with [[fever]], increased [[blood pressure]] and [[heart rate]], and [[hallucinations]].<br />
<br />
===Vital Signs===<br />
====Temperature====<br />
* [[Hyperthermia]]<br />
====Pulse====<br />
* [[Tachycardia]]<br />
====Blood Pressure====<br />
* [[Hypertension]]<br />
====Respiratory Rate====<br />
* [[Tachypnea]]<br />
<br />
===Eye===<br />
* [[Mydriasis]]<br />
* [[Positional nystagmus]]<br />
===Neurologic===<br />
* [[Altered mental status]]<br />
* [[Disorientation]]<br />
* [[Global confusion]]<br />
* [[Tremor]]<br />
<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_overview&diff=1735048Delirium tremens overview2023-08-08T15:46:47Z<p>Zehra Malik: /* Laboratory Findings */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
==Overview==<br />
[[Alcohol]] has a [[depressant]] effect on the [[brain]] and [[nervous system]]. If [[alcohol]] is stopped abruptly after a long period of [[chronic]] usage, the [[brain]] and [[nervous system]] struggle to recalibrate which leads to [[overstimulation]] of the [[brain]]. Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s [[Harlem]] slang; literally, "shaking delirium" or "trembling madness" in [[Latin]]) is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] or [[abstinence]] from [[alcoholic beverage|alcohol]] following [[alcoholism|habitual excessive drinking]], or [[benzodiazepines]] or [[barbiturates]] (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to [[benzodiazepine withdrawal syndrome|benzodiazepine]] or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with [[opiate]] addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
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==Historical Perspective==<br />
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==Classification==<br />
There is no established system for the classification of Delirium tremens.<br />
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==Pathophysiology==<br />
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==Causes==<br />
The most common cause of delirium tremens is abrupt [[alcohol]] cessation in [[chronic]] [[alcohol]] abusers.<br />
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==Differentiating Delirium tremens from Other Diseases==<br />
==Epidemiology and Demographics==<br />
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with [[opiate addiction]] (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.<br />
==Risk Factors==<br />
Common [[risk factors]] in the development of Delirium tremens include [[chronic]] [[alcoholism]], more days since last [[alcohol]] consumption, prior [[history]] of Delirium tremens, and extreme [[withdrawal symptoms]].<br />
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==Screening==<br />
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.<br />
==Natural History, Complications, and Prognosis==<br />
The [[symptoms]] of Delirium tremens usually start within 48 to 98 hours after the last drink in long term [[alcoholics]]. In some cases, it may occur up to 7 to 10 days after their last drink. Delirium tremens have a very high [[mortality rate]] if left untreated. [[Complications]] include, [[hypertension]], [[hyperthermia]], [[myocardial infarction|Heart attack]], [[cardiac arrhythmia]], [[stroke]], [[seizure]], [[respiratory failure]], [[altered mental status]], [[rhabdomyolysis]] and [[death]]. [[Prognosis]] largely depends upon early recognition and intervention. [[Mortality]] from Delirium tremens has been reduced from 35% to 5-15% due to early [[diagnosis]] and advanced [[ICU]] arrangements. Due to advanced treatment overall [[mortality]] is low, but it can vary in [[patient]] with other [[comorbidities]] including [[pulmonary]] insufficiencies, [[arrhythmia]], [[pancreatitis]], or if [[patient]] is older.<br />
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==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
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===History and Symptoms===<br />
The hallmark of delirium tremens is [[tremor]], [[confusion]], [[disorientation]], [[agitation]], signs of severe [[Autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]) with a positive history of [[alcohol]] cessation 48 - 72hrs prior in a patients with history of [[chronic]] [[alcohol]] abuse.<br />
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===Physical Examination===<br />
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===Laboratory Findings===<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
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===Electrocardiogram===<br />
[[Tachyarrhythmias]] are common [[ECG]] findings in [[patients]] with delirium tremens. [[Torsade de pointes]] can occur as prolonged [[QTc interval]] is strongly associated with heavy [[alcohol]] consumption.<br />
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===X-ray===<br />
An [[x-ray]] is important in [[patients]] with suspected delirium tremens, especially if they present with a [[fever]] or [[trauma]]. A [[chest]] [[x-ray]] should be obtained in [[patients]] with fever, as fifty-percent of these [[patients]] may have an [[infection]]. [[Pneumonia]] is the most common [[infection]].<br />
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===Echocardiography and Ultrasound===<br />
There are no [[echocardiography]]/[[ultrasound]] findings associated with delirium tremens. Due to the [[stress]] induced by delirium tremens, few cases of [[Takotsubo cardiomyopathy]] have been reported.<br />
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===CT scan===<br />
A CT scan of the head should be performed to evaluate any intracranial pathology.<br />
===MRI===<br />
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===Other Imaging Findings===<br />
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===Other Diagnostic Studies===<br />
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==Treatment==<br />
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===Medical Therapy===<br />
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=== Interventions ===<br />
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===Surgery===<br />
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===Primary Prevention===<br />
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Avoid or reduce the use of [[alcohol]]. Get prompt medical treatment for symptoms of alcohol withdrawal.<br />
===Secondary Prevention===<br />
==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs overview]]</div>Zehra Malikhttps://www.wikidoc.org/index.php?title=Delirium_tremens_laboratory_findings&diff=1735047Delirium tremens laboratory findings2023-08-08T15:45:43Z<p>Zehra Malik: /* Laboratory Findings */</p>
<hr />
<div>__NOTOC__<br />
{{Delirium tremens}}<br />
{{CMG}} {{AE}} {{VVS}} {{ZMalik}}<br />
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==Overview==<br />
[[Laboratory findings]] consistent with the [[diagnosis]] of delirium tremens include [[hypoglycemia]], [[hypomagnesemia]], [[hypophosphatemia]], and [[severe]] [[dehydration]].<br />
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== Laboratory Findings ==<br />
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=== Electrolyte and Biomarker Studies ===<br />
* [[Complete blood count]], [[differential count]]<br />
* Drug screening<br />
* Blood [[lactate]] levels<br />
* [[Osmolal gap]]<br />
* Serum levels of following electrolytes<ref name="pmid7348088">{{cite journal |author=Blay SL, Ferraz MP, Calil HM, Novo NF |title=[Plasma electrolyte changes in chronic alcoholic patients with and without delirium tremens] |language=Portuguese |journal=Acta Psiquiatr Psicol Am Lat |volume=27 |issue=4-5 |pages=311–4 |year=1981 |pmid=7348088 |doi= |url=}}</ref><br />
** [[Bicarbonate]] - decrease<br />
** [[Blood urea nitrogen]] (BUN) - may increase<br />
** [[Chloride]] - may remain unchanged<br />
** [[Creatine phosphokinase]] - Some patients develop [[rhabdomyolysis]]<br />
** [[Creatinine]] - may increase<br />
** [[Ketones]]<br />
** [[Lipase]] -<br />
** [[Liver function tests]] - abnormal<br />
** [[Magnesium]] - decrease<br />
** [[Potassium]] - decreased<br />
** [[Sodium]] - decreased<br />
* [[CSF]] examination - ruling out infections of the brain<br />
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==References==<br />
{{reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Substance abuse]]<br />
[[Category:Alcohol abuse]]<br />
[[Category:Abuse]]<br />
[[Category:Psychiatry]]<br />
[[Category:Neurology]]<br />
[[Category:Disease]]<br />
[[Category:Intensive care medicine]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Needs content]]<br />
[[Category:Needs overview]]</div>Zehra Malik