Abstract
The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium tremens that is refractory to benzodiazepine therapy. One potential therapy that is gaining traction is the use of phenobarbital, which may be mechanistically superior to benzodiazepines in treating delirium tremens because of its effects on GABA and N-methyl-D-aspartate receptors. The dosing of phenobarbital and its subsequent taper, however, is still unclear and the side effect profile is not well characterized. In this case report, we present the case of a 37-year-old Hispanic male who presented with alcohol withdrawal and subsequent delirium tremens who was treated with phenobarbital with positive clinical response and minimal side effects.
Highlights
Alcohol withdrawal and subsequent development of delirium tremens (DT) is a potentially life-threatening condition
On hospital day 4, approximately 75 hours after his last drink, he developed sinus tachycardia, hypertension, mild fever to 38°C, diaphoresis, visual and auditory hallucinations, and severe bilateral upper and lower extremity tremors consistent with DT. His withdrawal symptoms became refractory to escalating doses of IV lorazepam, and he was subsequently transferred to the intensive care unit (ICU) for higher level of care
The choice of additional therapy, is not standardized nor are there well-established regimens in place.[1]. This is important for high-risk patients such as those who have a personal or family history of alcohol withdrawal or DT.[3]
Summary
Alcohol withdrawal and subsequent development of delirium tremens (DT) is a potentially life-threatening condition. On hospital day 4, approximately 75 hours after his last drink, he developed sinus tachycardia (as high as 139 beats per minute), hypertension (as high as 188/112 mm Hg), mild fever to 38°C, diaphoresis, visual and auditory hallucinations, and severe bilateral upper and lower extremity tremors consistent with DT. His withdrawal symptoms became refractory to escalating doses of IV lorazepam, and he was subsequently transferred to the intensive care unit (ICU) for higher level of care. The patient was discharged home on hospital day 9 and he stated he would make an attempt to abstain from alcohol consumption
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