Delirium Tremens (DTs) Questions & Answers

Updated: Jun 14, 2019
  • Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM  more...
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Questions & Answers

Overview

What are delirium tremens (DTs)?

What is the role of alcohol withdrawal in the pathogenesis of delirium tremens (DTs)?

What is the role of ethanol and gamma-aminobutyric acid (GABA) interactions in the pathogenesis of delirium tremens (DTs)?

What is the role of ethanol and N -methyl-D-aspartate (NMDA) in the pathogenesis of delirium tremens (DTs)?

What are the risk factors for delirium tremens (DTs)?

What is the prevalence of delirium tremens (DTs)?

Why is delirium tremens (DTs) rarely seen in children?

What are the possible complications of delirium tremens (DTs)?

What is the mortality rate for delirium tremens (DTs)?

Which patients with delirium tremens (DTs) are at increased risk of death?

Presentation

What is alcohol withdrawal syndrome?

How is alcohol withdrawal syndrome categorized?

What are the signs and symptoms of minor alcohol withdrawal syndrome?

What are the signs and symptoms of major alcohol withdrawal syndrome (alcoholic hallucinosis)?

What are characteristics of withdrawal seizures (rum fits) associated with delirium tremens (DTs)?

What is the significance of alcohol withdrawal seizures in patients with delirium tremens (DTs)?

What are the signs and symptoms of delirium tremens (DTs)?

What is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) and how is it used in the evaluation of delirium tremens (DTs)?

What is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scale indicated in the assessment of delirium tremens (DTs)?

How is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scale scored?

What was revised in the updated Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AD) scale?

What is the role of the RASS (Richmond Agitation Sedation Scale) and Riker SAS (Sedation Agitation Scale) scales in the assessment of delirium tremens (DTs)?

What should be included in the physical exam for suspected delirium tremens (DTs)?

What are the clinical findings associated with delirium tremens (DTs)?

DDX

What are the diagnostic considerations for delirium tremens (DTs)?

Which conditions should be included in the differential diagnoses of delirium tremens (DTs)?

What are the differential diagnoses for Delirium Tremens (DTs)?

Workup

What should be included in the assessment of suspected delirium tremens (DTs)?

What should be included in serum chemistry studies for the diagnosis of delirium tremens (DTs)?

What is the role of lab testing in the diagnosis of delirium tremens (DTs)?

What is the role of imaging studies in the diagnosis of delirium tremens (DTs)?

What is the role of CT scanning in the evaluation of delirium tremens (DTs)?

When is a lumbar puncture indicated for the diagnosis of delirium tremens (DTs)?

Treatment

What are the special concerns in the treatment of delirium tremens (DTs)?

What are the limitations of sympatholytic drug for the treatment of delirium tremens (DTs)?

Which medications are used to treat alcohol withdrawal seizures in delirium tremens (DTs)?

What is the role of neuroleptic drugs in the treatment of delirium tremens (DTs)?

What is the role of alcohol in the prevention and treatment of delirium tremens (DTs)?

What role do sedatives play in the treatment of delirium tremens (DTs)?

What are concurrent illnesses associated with delirium tremens (DTs)?

When is hospital admission indicated for the treatment of delirium tremens (DTs)?

How is a dose escalation strategy used in the treatment of delirium tremens (DTs)?

What is the role of supportive therapy in the treatment of delirium tremens (DTs)?

What is included in supportive therapy for delirium tremens (DTs)?

What aspiration precautions are needed during treatment of delirium tremens (DTs)?

What is the role of thiamine in the treatment of delirium tremens (DTs)?

What is the role of magnesium in the treat of delirium tremens (DTs)?

What are the indications for magnesium in the treatment of delirium tremens (DTs)?

How is magnesium administered in the treatment of delirium tremens (DTs)?

What is the role of benzodiazepines in the treatment of delirium tremens (DTs)?

What is the role of ethanol in the treatment of delirium tremens (DTs)?

What is the efficacy of ethanol as a treatment for delirium tremens (DTs)?

When is the Revised Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) scale used in the treatment of delirium tremens (DTs)?

When is use of the Revised Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) scale contraindicated in the treatment of delirium tremens (DTs)?

What relapse prevention treatment is needed following treatment for delirium tremens (DTs)?

Which medications should be considered following inpatient treatment of delirium tremens (DTs)?

What is the role of cognitive behavioral therapy (CBT) and motivational enhancement therapy following treatment of delirium tremens (DTs)?

Why is a referral to a mental health provider needed following treatment of delirium tremens (DTs)?

How can delirium tremens (DTs) be prevented?

Which measures are effective in preventing delirium tremens (DTs)?

What is the effectiveness of brief interventions for heavy drinkers to prevent delirium tremens (DTs)?

Medications

What is the role of thiamine in the treatment of delirium tremens (DTs)?

Are there medication recommendations for the treatment of delirium tremens (DTs)?

What is the role of benzodiazepines for the treatment of delirium tremens (DTs)?

What is the role of benzodiazepines for the treatment of minor or moderate alcohol withdrawal?

What is the role of longer-acting benzodiazepines in the treatment of delirium tremens (DTs)?

What is the role of phenobarbital in the treatment of delirium tremens (DTs)?

When is phenobarbital used in the treatment of delirium tremens (DTs)?

What is the role of single dose phenobarbital in the treatment of delirium tremens (DTs)?

What are the treatment options for delirium tremens (DTs) following discharged from the emergency department (ED)?

What is the role of propofol in the treatment of delirium tremens (DTs)?

What is the role of dexmedetomidine in the treatment of delirium tremens (DTs)?

What is the role of clonidine and beta-blockers in the treatment of delirium tremens (DTs)?

What is the role of carbamazepine in the treatment of delirium tremens (DTs)?

What is the role of esmolol and midazolam in the treatment of delirium tremens (DTs)?

What is the role of neuroleptic drug therapy in the treatment of delirium tremens (DTs)?

What is the role of dopamine antagonists in the treatment of delirium tremens (DTs)?

Which medications in the drug class Vitamins and Nutrients are used in the treatment of Delirium Tremens (DTs)?

Which medications in the drug class Barbiturates are used in the treatment of Delirium Tremens (DTs)?

Which medications in the drug class Anesthetic agents are used in the treatment of Delirium Tremens (DTs)?

Which medications in the drug class Benzodiazepines are used in the treatment of Delirium Tremens (DTs)?