WITHDRAWAL DELIRIUM

DELIRIUM DEFINITION

• Delirium is defined as any acute disturbance in cognitive functions which is always accompanied by disturbance in consciousness.

Types of Delirium

• Hyperactive Delirium: In this type of delirium, the patient is aggressive, agitated and pulling out lines

• Hypoactive Delirium: this is only revealed by signs of inattention and decreased awareness of environment during close questioning.

• Mixed Form

Etiological classification – DSM-IV

• Delirium due to a general medical condition;• Substance-induced delirium including �

medication side-effects;• Delirium due to multiple aetiologies;• Delirium not otherwise specified.

Alcohol Withdrawal Delirium (Delirium Tremens)

• Alcohol withdrawal delirium (AWD) is the most serious form of alcohol withdrawal. It causes sudden and severe problems in your brain and nervous system.

• AWD is also known as delirium tremens or DTs. It is a medical emergency.

Epidemiology

• Approximately five percent of hospital patients being treated for alcohol withdrawal experience AWD.

• It has a greater propensity to develop in males than females

CAUSESAWD only affects people with a history of heavy alcohol use. Heavy drinkers may develop this condition if they:• suddenly stop drinking• reduce their alcohol use too quickly• don’t eat enough when reducing alcohol use• have a head injury• are sick or have an infection

RISK FACTORS

• have been drinking heavily for a long time• Age greater than 30 years• have a history of alcohol withdrawal• have a history of AWD• have other health problems in addition to

alcoholism• have brain damage

Symptoms of AWD

• Hallucinations• Diaphoresis• Agitation*• Low grade fever• Tachycardia*• Hypertension*• Disorientation

DIAGNOSIS• Diagnosis of AWD involves physical examination together

with results of tests including:• a toxicology screen to look for alcohol in your

blood• blood tests to measure magnesium and

phosphate• a comprehensive metabolic panel• an electrocardiogram (ECG) to check your heart

function• an electroencephalogram (EEG) to record the

electrical activity in your brain

CIWA-Ar cont.

• Each of the manifestations in the previous slide are noted on a scale of 0-7 according to severity

• The maximum possible score is 67• The level of treatment for alcohol withdrawal

will be dependent on the score obtained• Patients scoring less than 9 usually do not

require additional medication

TREATMENT AWD

• AWD can be fatal. Therefore, treatment should be received in a hospital and includes:

• intravenous fluids• anticonvulsants to prevent or stop seizures• sedatives to calm agitation and treat anxiety• antipsychotic medications to prevent hallucinations• medication to reduce fever• treatment for other alcohol related conditions• rehabilitation to help you stop drinking

Prognosis of AWD

• AWD can be deadly. This is particularly true if it remains untreated. Treatment significantly lowers your risks of complications and death.

• With timely medical treatment, AWD has very low death rate. However, some symptoms of alcohol withdrawal may last for more than a year. These include:

• Mood swings• Fatigue• Sleeplessness

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