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2010, vol. 44, iss. 3, pp. 15-20
Delirium tremens
Clinical Center Kragujevac, Clinic of Psychiatry
Keywords: alcohol withdrawal delirium; mortality; therapy
Abstract
Delirium tremens (DT) is a severe manifestation of alcohol withdrawal and it is defined as a delirium accompanied by autonomic hyperactivity and tremor occurring during or shortly after the alcohol withdrawal. Approximately 5% of patients hospitalized for alcohol withdrawal go on to develop delirium tremens. Although it only occurs in a relatively small number of patients who undergo alcohol withdrawal, it can be fatal. DT is a medical emergency that requires prompt recognition and treatment. The pathophysiological causes lie in an imbalance between the inhibitory and excitatory neurotransmitters after giving up alcohol. This results in predomination of the excitatory system. Risk factors associated with the development of DT include old age, history of DT or withdrawal seizures, history of epileptic seizures, presence of severe withdrawal symptoms on presentation, acute medical illness, hypokaliemia, history of heavy daily alcohol use, and abnormal liver function. The mortality rate for delirium tremens may be as high as 35% if untreated but is less than 5% with early recognition and treatment. Advanced age and comorbid medical or surgical disorders are associated with the increased risk of death. The most common conditions leading to death in these patients are respiratory failure and cardiac arrhythmias. There is no consensus about the therapeutic guidelines for the treatment of delirium tremens. We discussed some therapeutic questions in order to improve the treatment outcomes.
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article language: Serbian
document type: Review Paper
published in SCIndeks: 08/04/2011