Delirium tremens medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
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. | |||
Contraindication: Incase of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]]. | |||
OR | OR | ||
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==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. | *Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. | ||
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3]. | *Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3]. | ||
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2]. | *Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2]. | ||
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2]. | *Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2]. | ||
=== | ===Delirium tremens=== | ||
REGIMES DOSES | |||
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 | |||
5 mg IV → 5 mg IV (repeat after 10 min) | |||
10 mg IV → 10 mg IV (repeat after 10 min) | |||
20 mg IV after 10 min | |||
5–20 mg IV per hour | |||
[Dosing must be continued till the aim of light sedation or the CIWA-Ar score has been achieved] | |||
Symptom triggered With diazepam 10–20 mg IV every 1–4 h → repeat doses till CIWA-Ar score <8 | |||
With lorazepam: 4 mg IV to be repeated every 10 min till either of the aims of front loading is achieved | |||
If severe delirium still persists even after 16 mg IV→ 8 mg IV bolus is to be administered | |||
Fixed dose Not to be used for DT; Only for outpatient management of alcohol withdrawal syndrome | |||
Open in a separate window | |||
CIWA-Ar: Clinical Institute Withdrawal Assessment-Alcohol (revised); IV: Intravenous. | |||
==References== | ==References== | ||
Revision as of 15:49, 10 August 2023
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
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.
Contraindication: Incase of liver impairment or lack of IV access, lorazepam is preferred over diazepam.
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
- Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
- Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
- Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
- Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Delirium tremens
REGIMES DOSES 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 5 mg IV → 5 mg IV (repeat after 10 min) 10 mg IV → 10 mg IV (repeat after 10 min) 20 mg IV after 10 min 5–20 mg IV per hour [Dosing must be continued till the aim of light sedation or the CIWA-Ar score has been achieved] Symptom triggered With diazepam 10–20 mg IV every 1–4 h → repeat doses till CIWA-Ar score <8 With lorazepam: 4 mg IV to be repeated every 10 min till either of the aims of front loading is achieved If severe delirium still persists even after 16 mg IV→ 8 mg IV bolus is to be administered Fixed dose Not to be used for DT; Only for outpatient management of alcohol withdrawal syndrome Open in a separate window CIWA-Ar: Clinical Institute Withdrawal Assessment-Alcohol (revised); IV: Intravenous.
References
Medical Therapy
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with benzodiazepines, 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, seizures 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.