Delirium/Alcohol Withdrawal

Question 0

Two threatening and potentially reversible causes of delirium?

Answer 0

Hypoxia and hypoglycemia

Question 1

Delirium typically becomes most severe at what time of day?

Answer 1

Evening and at night

Patient most lucid on morning rounds

Question 2

50% of elderly patients have delirium after this surgery?

Answer 2

Hip surgery following hip fracture

Question 3

Treatment for agitation with psychotic symptoms (hallucinations and delusions)?

Answer 3

Low-dose haloperidol or risperidone

Question 4

Do not give this drug with Delirium?

Answer 4

Benzodiazepines – they worsen confusion

Question 5

Alcohol withdrawal symptoms? (And times)

Answer 5

Tremulousness (within six hours) – shakes, anxiety, easy startling, anxiety, diaphoresis, palpitations

seizures (6 to 48 hours) – tonic-clonic seizures occurring in clusters of 2 to 6 episodes

Alcoholic hallucinosis (12 to 48 hours) – mostly visual. Can be maligning voices.

Delirium tremens (48 to 72 hours) – hallucinations, agitation, and sympathetic hyperactivity (dilated pupils, fever, tachycardia, hypertension, diaphoresis, hyperventilation)

Question 6

Drug of choice for alcohol withdrawal?

Answer 6

Benzodiazepines

Question 7

Treatment plan for alcohol withdrawal?

Answer 7

1. Either diazepam or lorazepam to make patient heavily sedated but responses
2. Rapid downward titration as agitation decreases, usually over 48 to 72 hours
3. Hydration, replacement of electrolytes, thiamine, B12

Question 8

Why is delirium tremens a medical emergency?

Answer 8

Associated with a 5 to 15% mortality