The varied clinical manifestations and management of 14 male patients with delirium tremens rigido tremens DT have been delirium tremens rigido. Eight patients were initially hospitalised for diseases unrelated to ethanol abuse i.
One patient was going through withdrawal because of prodrome of viral hepatitis before he was hospitalised for uncontrolled agitation and delirium. Three patients presented denovo delirium tremens rigido DT without concomitant illness. The other features besides delirium and hallucinations were tremulousness in 10, tachycardia in 12, fever in 3, diaphoresis in 2 and tonic clonic seizures in 4 patients. The symptoms delirium tremens rigido markedly at short intervals and 2 patients did not have any features of sympathetic overactivity.
Altered hepatic biochemical parameters and ketonuria delirium tremens rigido normal blood sugar were noted in 4 and one patients respectively. Other biochemical parameters including serum electrolytes were normal. CT scan brain done for 5 patients revealed subdural haematoma in one. All made good recovery with heavy doses of intravenous vitamin B complex, glucose and oral benzodiazepine.
Short course of haloperidol was used in 2 patients. Two patients developed pancreatitis delirium tremens rigido follow up. All patients made complete recovery, and 8 patients have been followed for 8 to 12 months without relapse.
The reason for hospitalisation in such cases is often unrelated to alcohol abuse; hence a detailed history of alcoholism is mandatory to identify those at risk as well as for prompt treatment and decreasing the mortality. Delirium tremens DT - an acute psychosis which follows abstinence from alcohol - is delirium tremens rigido most severe form of acute alcohol withdrawal syndrome occurring in a chronic alcoholic. In persons who have been drinking heavily over a prolonged period, any rapid decrease in the amount of alcohol delirium tremens rigido the body is likely to produce a variety of symptoms.
The withdrawal or abstinence syndrome is characterized by coarse delirium tremens rigido of the hands, insomnia, nausea, vomiting, psychomotor delirium tremens rigido, anxiety, transient visual, tactile or auditory hallucinations, alongwith increase in sweating, body temperature, heart rate, respiratory rate and blood pressure.
When the symptoms of withdrawal are accompanied by a state of severe agitated confusion or delirium, sometimes associated with tactile or visual hallucinations, the diagnosis of alcohol withdrawal delirium tremens rigido also called delirium tremens is made. Chronic alcohol abusers delirium tremens rigido admitted with alcohol unrelated diseases develop the syndrome of acute delirium tremens rigido withdrawal due to forced abstinence in hospital. Lack of proper history by the doctor and incorrect reporting about alcohol consumption by the patient delay the diagnosis of DT in such circumstances.
DT in such cases is usually considered only after causes of agitation related to the patient's primary diagnosis for admission are ruled out. This leads to a delay in delirium tremens rigido and more frequent occurrence of complications. The study was carried out to find out clinical profile of patients with DT, especially in those admitted to hospital with diseases mainly unrelated to ethanol abuse.
The presentation, biochemical profile and management were studied and analysed. This descriptive, observational, hospital-based study comprised 14 cases admitted to a large service hospital from March to March The patients included in the study were admitted to medical and surgical wards.
Patients admitted to psychiatry ward for management of DT were not included in the study. The cases selected for study were those who had classical features of DT while in hospital or those admitted with these features following alcohol withdrawal and volunteering a history of chronic alcohol abuse. All relevant haematological and biochemical investigations were performed and the patients were followed up during their hospitalisation for problems encountered in management and response to treatment.
CT scan head and EEG were carried out in 5 and 3 patients respectively. EEG could not be carried out delirium tremens rigido all cases because of various constraints. All the 14 patients were males and their age ranged from 33 to 56 years with the mean being All the patients had been taking alcohol for an average period of 10 years and were dependent on alcohol.
They were however in good general health. Of the 14, nine patients Of these, 2 patients Two patients each were admitted with myocardial infarction and stroke, and one each with pneumonia and gastroenteritis. One patient could not consume alcohol because of prodrome of viral hepatitis and was hospitalised with uncontrolled delirium of 12 hours duration.
Of the remaining 5, three were admitted with frank DT after cessation of alcohol for 5 to 9 days with no other concomitant disorder. Two patients - known cases of mild primary hypertension on dietary therapy-were hospitalised with features of agitation, abnormal behaviour, a single episode of generalised tonic-clonic seizure and hypertensive encephalopathy. Both of these could not obtain alcohol for 6 days prior to this episode.
The symptoms fluctuated markedly at short intervals and 2 patients delirium tremens rigido Of the 14 patients, 6 had delirium at onset The delirium delirium tremens rigido in the form of marked confusion in 8, aggressive behaviour in 4 and tactile hallucination in 2 cases. Two patients CT head performed in 5 patients revealed a subdural haematoma subsequently evacuated in one patient.
The liver function tests i. One patient had persistent vomiting and ketonuria for 48 hours though his delirium tremens rigido sugar remained normal throughout. The other details of various signs, symptoms and biochemical parameters are depicted in Fig. Two patients required low dose haloperidol for 2 to 3 weeks for controlling the abnormal behaviour. All the cases made a complete and uneventful recovery.
Eight cases were followed up for months, and during this period 2 developed pancreatitits in spite of not consuming alcohol.
The clinical manifestations of ethanol withdrawal are divided into four overlapping syndromes i. These were all noticed in varying degree in our study.
Though various symptoms and signs of withdrawal may begin as early as 5 hours after decreasing the intake, the onset of DT without co-morbid condition is rare before 48 to 72 hours of cessation of alcohol.
It may be delayed as long as 5 to 14 days [ delirium tremens rigido5 ]. In our study the period of alcohol deprivation ranged from 12 hours to 9 days. Though the average age of alcohol dependence is about 35 years, in our study it averaged about 45 years. This could be related to good delirium tremens rigido status and some form of restriction on excessive alcohol intake related to the regimental life.
The concomitant illnesses as encountered in our study not only shorten the onset period of DT but also modify, mask or aggravate the presentation. In fact, most patients with DT have severe concomitant medical problems requiring immediate treatment [ 6 ]. Distinguishing DT from hepatic encephalopathy is usually difficult as these conditions often co-exist [ 7 ]. Our case of viral hepatitis could be labelled as having DT as after control of delirium his liver function deteriorated further for 3 weeks.
Seizures could be common features in DT and hypertensive encephalopathy but in the latter, retinal changes have diagnostic value as was noted in 2 cases in our series. During withdrawal, there may be moderate hypertension due to sympathetic overactivity and this response can be aggravated in those with existing hypertension. The likelihood of developing DT is known to increase with conditions like pneumonia and gastroenteritis [ 38 ].
This was also delirium tremens rigido in our study. Patients are often admitted for other problems and develop withdrawal state in hospital due to forced abstinence. It is mandatory to exclude metabolic traumatic and infective disorders in patients showing features of ethanol withdrawal.
Medical conditions which must be considered in differential diagnosis include hypoglycaemia, hepatic failure and diabetic ketoacidosis. This high incidence can be attributed to other co-morbid conditions which existed in these patients.
Alcohol ketoacidosis usually develops when alcohol consumption is abruptly curtailed. It is usually associated with nausea, vomiting, abdominal pain, starvation and delirium tremens rigido depletion. It can be differentiated from diabetic ketoacidosis by glucose concentration which is low or normal.
It was encountered in one of our patients. Mortality due to DT in absence of concomitant diseases has decreased due to modern treatment. There was no mortality in our series. The ideal treatment of DT is controversial. Most clinicians use benzodiazepines with long half life like diazepam or chlordiazepoxide. Delirium tremens rigido average patient requires 25 to 50 mg of chlordiazepoxide or 10 mg of diazepam given orally every hours on the first day. Additionally, intravenous thiamine and glucose is administered.
Short term antipsychotics like haloperidol are occasionally required. They were delirium tremens rigido by us in 2 patients for weeks to control their abnormal behaviour. Eight cases were followed up for months, and during this period 2 developed pancreatitis despite abstaining from alcohol.
National Center for Biotechnology InformationU. Med J Armed Forces India. Published online Jul Author information Copyright and License information Disclaimer. Abstract The varied clinical manifestations and delirium tremens rigido of 14 male patients with delirium tremens DT have been studied.
Introduction Delirium tremens DT - an acute psychosis which follows abstinence from alcohol - is the most severe form of delirium tremens rigido alcohol withdrawal syndrome occurring in a chronic alcoholic.
Material and Methods This descriptive, observational, hospital-based study comprised 14 cases admitted to a large service hospital from March to March Results All the 14 patients were males and their age ranged from 33 to 56 years with the mean being Open in a separate window. Discussion The clinical manifestations of ethanol withdrawal are divided into four overlapping syndromes i.
References 1. Rosenbloom A. Emerging treatment options in alcohol withdrawal syndrome. J Clin Psychiatry. Johns AR.