Delirium tremens (psychoactive substance use)

Question 1

What causes delirium tremens?

Answer 1

-Alcohol withdrawal causing rapid onset confusion
-Present with profound confusion, autonomic hyperactivity and cardiovascular collapse

Question 2

What risk factors are there for DT?

Answer 2

-PMH of DT and alcohol withdrawal seizures
-Co-existing infection / medical problems eg hepatitis, pancreatitis
-Older age
-Abnormal liver function

Question 3

How does DT present?

Answer 3

-Onset is typically 48-72h post withdrawal
-Signs of altered mental status
-Hallucinations
-Confusion
-Delusions
-Severe agitation
-Seizures

Question 4

How would you investigate a patient with DT?

Answer 4

-Clinical diagnosis
-Full bloods to assess for dehydration, electrolyte imbalance
-ABG to look for metabolic acidosis
-Amylase (liver damage)
-Creatine phosphokinase (risk of rhabdomyolysis if pt unconscious for some time)
-CXR if signs of respiratory distress / look for co-exiting pneumonia
-CT head if seizures present

Question 5

What treatment would you consider for a patient with DT?

Answer 5

-ICU
-ABCDE approach
-Treat hypoglycaemia
-Sedation with benzos is suggested (diazepam has rapid onset)
-Give Pabrinex if concerns about WKS
-Magnesium can protect against seizures / arrhythmias