Alcohol Withdrawal Delirium

1. DELIRIUM TREMENS Ade Wijaya, MD – October
2018

2. INTRODUCTION
• Alcohol use disorders can decrease life span and impair social
functioning
• 50 % alcohol use disorders  alcohol withdrawal
• Alcohol withdrawal can cause delirium (3-5%)  delirium tremens
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. DSM-5. Washington, DC: American Psychiatric Publishing, 2013.
Schuckit MA. Alcohol-use disorders. Lancet 2009;373:492-501.
Mertens JR, Weisner C, Ray GT, Fireman B, Walsh K. Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs. Alcohol Clin Exp Res

3. PATHOPHYSIOLOGY
• Alcohol is a CNS depressant
• Increase GABA release in the brain with prominent effects on GABA
type A (GABAA) receptors, and it inhibits postsynaptic N-methyl-d-
aspartate glutamatereceptor activity.
• Brain can adapt with repeated exposure
Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003;348:1786-95.
Schuckit MA. Ethanol and methanol. In: Brunton LL, Chabner BA, Knollmann BC, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 12th ed. New York:
McGraw-Hill, 2011: 629-47.

4. WITHDRAWAL SYMPTOMS
• Insomnia
• Anxiety
• Increased pulse and respiration rates, body temperature, and blood
pressure
• Hand tremor
•Because of the short action of ethanol (beverage alcohol), withdrawal
symptoms usually begin within 8 hours after blood alcohol levels
decrease, peak at about 72 hours, and are markedly reduced by day 5
through 7 of abstinence.
Mainerova B, Prasko J, Latalova K, et al. Alcohol withdrawal delirium — diagnosis, course and treatment. Biomed Pap Med Fac Univ Palacky Olomouc Czech
Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003;348:1786-95.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. DSM-5. Washington, DC: American Psychiatric Publishing, 2013

5. DELIRIUM TREMENS
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. DSM-5. Washington, DC: American Psychiatric Publishing, 2013

6. ALCOHOL WITHDRAWAL
ASSESTMENT
Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003;348:1786-95.

7. TREATMENT
Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). New England Journal of Medicine. 2014 Nov 27;371(22):2109-13.

8. SUMMARY
• Alcohol withdrawal is a part of alcohol use disorders
• Mild to severe symptoms  delirium tremens
• IV Diazepam is the main treatment modality