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Medicinski časopis
2010, vol. 44, br. 3, str. 15-20
jezik rada: srpski
vrsta rada: pregledni članak
objavljeno: 08/04/2011
Delirijum tremens
Klinički centar Kragujevac, Klinika za psihijatriju

Sažetak

Delirium tremens (DT) je ozbiljna manifestacija alkoholne apstinencijalne krize. Definiše se kao delirijum praćen autonomnom hiperaktivnošću i tremorom za vreme konzumiranja alkohola ili ubrzo posle prestanka konzumiranja alkohola. Učestalost DT je oko 5% kod hospitalizovanih pacijenata koji su prestali sa konzumiranjem alkohola. Iako se javlja kod relativno malog broja pacijenta, zbog velike smrtnosti, zahteva brzo prepoznavanje i tretman. Patofiziološki uzroci nastanka DT leže u neravnoteži između inhibitornih i ekscitatornih neurotransmitera posle prestanka konzumiranja alkohola. Posledica ovih promena je predominacija ekscitatornih neurotransmitera. Faktori rizika za razvoj DT su: starost, prethodne epizode delirijum tremensa, postojanje epileptičnih napada, ozbiljni apstinencijalni simptomi pri dolasku na lečenje, akutne medicinske bolesti, hipokaliemija, svakodnevno opijanje i oštećenje jetre. Stopa smrtnosti može da ide i do 35% ukoliko se ne leči, ali je manja od 5% ukoliko se rano dijagnostikuje i počne sa lečenjem. Starost i udružene bolesti, internističke ili hirurške povezani su sa povećanim rizikom od smrti. Kao najčešći razlozi koji uzrokuju smrt kod pacijenata sa DT pominju se respiratorna insuficijencija i srčana aritmija. Ne postoje usaglašene terapijske smernice za tretman delirijum tremensa. U radu smo pažnju posvetili nekim terapijskim dilemama s ciljem da se poboljša ishod lečenja kod pacijenata s delirjum tremensom.

Ključne reči

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