Alcohol withdrawal

Objective: This case review discusses the current recommended protocol for the diagnosis and treatment of delirium tremens using a review of a patient managed both in an inpatient psychiatry unit and in an intensive care unit. This review and case study are intended to help guide patient care with co-morbid conditions confounding diagnosis and in facilities lacking sophisticated monitoring equipment. Data Sources: PubMed was searched using keywords and phrases, including delirium tremens, alcohol withdrawal, chronic alcoholism, CIWA, alcohol effect on CNS, treatment of delirium tremens, and treatment of alcohol withdrawal. Study Selection: The case discussed provided the basis for this report based on its complexity due to comorbid conditions and the initial subacute presentation. Data Extraction: Data were gathered from charting notes written concurrently with patient management. Vital signs and laboratory values were regularly measured, and healthcare faculty documented each clinical encounter with findings and updates to treatment. Results: Delirium tremens was identified before progression to seizures and severe autonomic instability. Appropriate treatment and transfer to an intensive care unit were secured once a significant index of suspicion was reached. Conclusions: Close and frequent patient evaluation despite the lack of continuous monitoring technology allowed detection of decompensation as it began insidiously. The gradual development of cognitive symptoms and the presence of abnormal laboratory results helped identify his deterioration. The current guidelines for the treatment of delirium tremens provide the basis for the management of this highly dangerous disorder. Key Words: Delirium tremens, alcohol withdrawal biomarkers, geriatric delirium