Addictions Flashcards
What are the symptoms of delirium tremens?
DT is defined by hallucinations, disorientation, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis in the setting of acute reduction or abstinence from alcohol.
What is the time frame for DTs?
DT typically begins between 48 and 96 hours after the last drink and lasts one to five days
Laboratory findings in DT?
Patients with DT have significantly elevated cardiac indices, oxygen delivery, and oxygen consumption [14]. Arterial pH rises due to hyperventilation, which may be a rebound effect related to the respiratory depressant properties of alcohol. Hyperventilation and consequent respiratory alkalosis in this setting result in a significant decrease in cerebral blood flow [15]. There is a correlation between the length of the preceding alcohol binge, the degree of clouding of the sensorium, and the size of the average decrease in cerebral hemispheric blood flow, although there is no association between blood flow parameters and hallucinations or tremors [15].
Severe alcohol withdrawal is often associated with fluid and electrolyte status abnormalities. Almost all patients in acute withdrawal are hypovolemic as a result of diaphoresis, hyperthermia, vomiting, tachypnea, and decreased oral intake. Hypokalemia is common due to renal and extrarenal potassium losses, alterations in aldosterone levels, and changes in potassium distribution across the cell membrane [16,17]. Hypomagnesemia is common in patients with DT and may predispose to dysrhythmias and seizures [18]. Hypophosphatemia may occur due to malnutrition, may be symptomatic, and if severe, may contribute to cardiac failure and rhabdomyolysis.
Risk factors for DT?
●A history of sustained drinking
●A history of previous DT
●Age greater than 30
●The presence of a concurrent illness
●The presence of significant alcohol withdrawal in the presence of an elevated alcohol level
●A longer period since the last drink (ie, patients who present with alcohol withdrawal more than two days after their last drink are more likely to experience DT than those who present within two days)
Define alcoholic hallucinosis?
Alcoholic hallucinosis refers to hallucinations that develop within 12 to 24 hours of abstinence and typically resolve within 24 to 48 hours (which is the earliest point at which delirium tremens typically develops) (table 1) [13].
How do you differentiate between alcoholic hallucinosis and DT?
in contrast to delirium tremens, alcoholic hallucinosis is not associated with global clouding of the sensorium but only with specific hallucinations, and vital signs are usually normal. DT and alcoholic hallucinosis are NOT synonymous and symptoms that occur a few hours after the cessation of drinking, even if severe, are usually not manifestations of DT.
