Delirium tremens

Delirium tremens is a medical emergency. It is an acute confusional state associated with tremor and autonomic dysfunction.

The essential feature is that it develops within one week following the cessation of heavy ingestion of alcohol or a reduction in the amount of alcohol ingested. (1)

Treatment for delirium tremens or seizures; (1,2)

• offer oral lorazepam as first-line treatment for delirium tremens. If symptoms persist or oral medication is declined, give parenteral lorazepam, haloperidol or olanzapine
• for people with alcohol withdrawal seizures, consider offering a quick-acting benzodiazepine (such as lorazepam) to reduce the likelihood of further seizures
• if delirium tremens or seizures develop in a person during treatment for alcohol withdrawal, review their withdrawal drug treatment
• do not offer phenytoin to treat alcohol withdrawal seizures
• in benzodiazepine refractory cases, phenobarbital, propofol, and dexmedetomidine can also be used

Reference:

1. Grover S, Ghosh A; Delirium Tremens: Assessment and Management. J Clin Exp Hepatol. 2018 Dec;8(4):460-470.
2. National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. April 2017 [internet publication].