Alcohol withdrawal and delirium

Physical dependence on alcohol can be fatal if the patient stops suddenly. This is often the case for patients coming into hospital who will then develop symptoms of alcohol withdrawal which is why it is important to recognise these symptoms. Diagnosis is clinical.

Uncomplicated Withdrawal

• Shakes
• Sweating
• Nausea/Vomiting
• Mood disturbance
• Hyperacusis
• Autonomic symptoms
• Agitation

Delirium Tremens (DTs)

Delirium tremens is a delirium specifically due to alcohol withdrawal and has the following clinical features:

Perceptual Disturbances

• 8-12 hours after cessation
• Illusions or hallucinations
  • In any modality
  • Often interactive
  • 'Lilliputian visual hallucinations' (miniature humans or animals) are typical
  • Confabulation

Seizures

• Up to 2 days after cessation
• Generalised tonic-clonic
• 5-15% of dependant drinkers
• Predisposed in: previous history, epiplepsy, low potassium/magnesium

The diagnosis is made clinically

Management

Give em benzos, such as chlordiazepoxide. It can be fatal, and in severe cases an alcohol drip may be used, then the patient is slowly weaned off.