1. ALCOHOL WITHDRAWAL DELIRIUM
Leenard Michael A. Sajulga, RN

2. Alcohol withdrawal delirium
• Delirium tremens
• Alcoholic hallucinosis
• An acute toxic state that follows a prolonged
bout of steady drinking or sudden withdrawal
from prolonged intake of alcohol

3. Alcohol withdrawal delirium
• It may be precipitated by acute injury or
infection
• Symptoms can begin as early as 4 hours after
a reduction of alcohol intake and usually peak
at 24 to 48 hours, but may last up to 2 weeks.

4. NURSING ALERT
Alcohol withdrawal delirium is a
serious complication of inadequate
withdrawal management and is life-
threatening.

5. PRIMARY ASSESSMENT AND
INTERVENTIONS

6. • Patient will present alert, unless experiencing
a seizure
• If the patient is having a seizure, ensure the
airway.

7. SUBSEQUENT ASSESSMENT

8. • Assess for major symptoms—may occur
independently or in combination.
– Tremors
– Seizures
– Hallucinations (usually tactile)
• Obtain drinking history, including the severity
of past withdrawal episodes and any recent
drug intake.

9. • Be aware that people tend to underestimate
drinking habits.
• Assess complaints of nausea and
vomiting, malaise, weakness, anxiety, or fear.
• Perform thorough examination for signs of
autonomic hyperreactivity

10. – tachycardia, diaphoresis, elevated
temperature, dilated but reactive pupils
• Signs of coexisting illnesses or injuries
– head injury, pneumonia, metabolic disturbances
• Observe behavior for
talkativeness, restlessness, agitation, or
preoccupation.

11. GENERAL INTERVENTIONS

12. • Protect the patient from injury.
– The hallucinations may be visual, tactile, or auditory and
are frequently frightening.
• Take a breath analyzer reading—indicates where
patient is in the withdrawal process.
• Using a nonalcoholic skin preparation, draw blood
for measurement of ethanol
concentration, toxicologic screen for other drugs of
abuse

13. • Pharmacologic interventions:
– Diazepam (Valium) or chlordiazepoxide (Librium)
for sedation. Sedate the patient with sufficient
dosage of medication to produce adequate
relaxation and to reduce agitation, prevent
exhaustion, and promote sleep.
– Diazepam (Valium) or phenytoin (Dilantin) for
seizure control.
• Monitor vital signs every 30 minutes.

14. • Place the patient in a private room for close
observation.
• Maintain electrolyte balance and hydration through
oral or I.V. route—fluid losses may be extreme
because of profuse perspiration, vomiting, and
agitation.
• Assess respiratory, hepatic, and cardiovascular
status of patient—pneumonia, liver disease, and
cardiac failure are complications.

15. • Observe for hypoglycemia, and treat appropriately.
Hypoglycemia may accompany alcoholic withdrawal
because alcohol depletes liver glycogen stores and
impairs gluconeogenesis; many patients also suffer
from malnutrition.
– Administer thiamine followed by parenteral dextrose if
liver glycogen is depleted.
– Give orange juice, Gatorade, or other carbohydrates to
stabilize blood sugar and to counteract tremulousness.