Development Of Delirium Tremens Research Articles

Optimization of Intensive Care of Patients with Delirium Tremens

Objective: to improve intensive therapy for acute ethanol intoxications complicated by the development of delirium tremens. Subjects and methods. The data of examination and treatment were analyzed in 173 patients with acute severe ethanol intoxications complicated by the development of delirium tremens, out of them 105 patients received Cytoflavin incorporated into a treatment regimen and 68 patients were treated according to convention al procedures. In addition to physical examination, the clinical course of the disease, blood gas composition and water electrolyte balance parameters, and circulating blood volume were estimated by a dye hematocrit method. Results. Correction of somatic dysfunctions and metabolic disorders with Cytoflavin along with medical sleep was found to lead to rapid arrest of the signs of the psychosis, to prevent brain edema, to have a positive impact on the further status of patients, to considerably reduce the period of asthenization and to ameliorate its manifestations. Conclusion. The findings may serve as a basis for the wide use of Cytoflavin in a treatment regimen in narco logical practice since it leads to normalization of metabolic processes and hence to a more rapid recovery.

Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting

Background The clinical expressions of alcohol withdrawal syndrome (AWS) may vary and the factors determining these variations are not well-known. It would be useful to have a set of clinical tools capable of predicting which patients are likely to develop the more severe forms of the syndrome. Aim To analyse the clinical variables associated with the development of delirium tremens (DTs) in patients who were admitted to a general hospital with AWS. Methods Cohort study of AWS patients admitted to the Xeral Hospital in Lugo, Spain, between 1987 and 2003. The characteristics of patients with the syndrome who did not develop delirium tremens were contrasted with those who did. Cases presenting with DTs at diagnosis were excluded. The different clinical, epidemiological and biochemical variables reflective of alcohol consumption habits, basal health status and presentation features of syndrome were all recorded. Results Data from 156 episodes of AWS that coursed without DTs were compared with 147 cases that coursed with it. Three independent variables for development of DTs were identified in a multivariate logistic regression model: number of seizures [1 or 2: OR 2.2 (CI 95% 1.2–3.8), p = 0.005; 3 or more: OR 2.6 (CI 95% 1.04–6.8), p = 0.04]; systolic blood pressure > 150 mm Hg [OR 1.9 (CI 95% 1.1–3.8), p = 0.03] and axillary temperature > 38 °C [OR 1.9 (CI 95% 1.05–3.5), p = 0.01]. ROC analysis revealed an area under the curve of 0.679. Conclusion Three clinical findings (seizures, blood pressure and temperature) can aid in identifying patients with AWS who are likely to develop DTs. The model's predictive capacity is not high.

Risk factors for delirium tremens in trauma patients.

The development of delirium tremens (DT) is associated with significant morbidity and mortality. This study identifies characteristics in trauma patients that are predictive of DT. Data from 1,856 trauma patients who either developed DT (n = 105) or had a positive blood alcohol concentration but did not develop DT (n = 1,751) were collected from the trauma registry of a Level I trauma center. Odds ratios were used to measure the association between predictors and DT as an outcome and between DT and length of stay as an outcome. Of seven significant (p < 0.05) predictors of DT, four were retained after stepwise logistic regression: age >40, white race, burn as a mechanism of injury and, as a negative predictor, motor vehicle collision as a mechanism of injury. The DT group stayed an average of 6.5 and 5.2 days longer in the hospital and the intensive care unit, respectively, than those in the control group. It is possible to determine which intoxicated trauma patients are at increased risk for DT using the above predictors. Patients who develop DT have worse outcomes than those who do not. Whether routine DT prophylaxis would improve outcomes among those at increased risk for DT is unknown, but deserves further study.

Delirium tremens. Some clinical features. Part I.

Twenty patients with delirium tremens and related states were investigated from the time of admission until the acute state was over. Using strict diagnostic criteria the material was divided into two groups according to the severity of the clinical condition; nine patients had fully developed delirium tremens (grade 3), 11 patients had a less severe clinical state, known as "Predelirium" (grade 2). The material was found to be representative for the condition under discussion. Patients with grade 2 were admitted during the day and the evening, but not during the night; patients with fully developed delirium tremens (grade 3) were admitted during both the day and the night, and this difference is discussed. The two groups had the same pattern of alcohol abuse, but patients with proper delirium tremens had had a drinking bout preceding the acute state; this was not seen among patients with a less severe clinical state. Patients with grade 2 had had symptoms like sleep disturbances and gastro-intestinal disturbances for 12-24 hours before the admission, whereas grade 3 patients had had such symptoms for about 48 hours. Patients with grade 2 stopped drinking when the first symptoms of the acute state appeared, whereas patients with fully developed delirium tremens continued to drink in spite of their condition. These anamnestic were supported by the finding that significantly more patients with proper delirium tremens had alcohol in the blood--several even concentrations about 2 g/l--at the time of admission compared to patients with a less severe clinical state. This lack of "latency period", which previously has been described as a typical feature in the development of delirium tremens, is discussed. It is concluded that due to the methodology used, it has been possible to point out some of the differences between the milder, often harmless, conditions and the potentially serious, fully developed delirium tremens.