DELIRIUM TREMENS Flashcards
DTs - Incidence and mortality
5% DTs (35% mortality if untreated)
Why to DTs occur?
ETOH is a depressant. When ETOH withdrawn, excitability increases and inhibition decreases = overactive CNS
Approach to treatment - DTs
IV fluids vitamins? (B1 - thiamin, B9 - folic acid, B12 - cobalamin) fix lytes? (mag, ca…) Benzos (loading dose if acute) Barbituates if refractory
Benzos vs Barbituates for DTs
1st Benzos - high TI (high doses before resp depression)
2nd Barbituates - narrow TI (more resp depression)
Midazolam (Versed), Oxazepam (Serax) and Triazolam (Halcion) - class?
Benzodiazepines (short acting <10 hrs)
Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan) - class?
Benzodiazepines (intermittent 10-24 hrs)
Clorazepate (Tranxene), Chlordiazepoxide (Librium), Diazepam (Valium) - class?
Benzodiazepines (long acting >24 hrs)
Which long acting Benzo is good for acute DTs (because rapid) and self tapering (because long acting) but DDI may be of concern because inhibitor of 2C19 and 3A4?
Diazepam (Valium)
Treatment options if DTs are refractory to Benzos?
Barbituates (phenobarb or pentobarb)
Propofol (if intubated)
MgSO4 if hypoMg
alpha 2 receptor agonists (Clonidine, guanfesine, methydolpa b/c decrease sympathetic tone)
Beta Blocker (metoprolol or propranolol - want lipophilic to penetrate CNS)
CCB if hyper reactive airway disease (b/c no BB)
Phenobarbital and Pentobarbital - class?
Barbiturates