Delirium tremens ( DTs ) is a quick start of the confusion usually caused by withdrawal from alcohol. When that happens, it is often three days into withdrawal symptoms and lasts for two to three days. Physical effects may include shaking, chills, irregular heartbeat, and sweating. People may also see or hear things that others do not. Sometimes, very high temperatures or body spasms can cause death. Alcohol is one of the most dangerous drugs to be withdrawn.
Delirium tremens usually only occur in people with high alcohol intake for more than a month. Similar syndromes can occur with benzodiazepines and barbiturate withdrawals. Withdrawal from a stimulant such as cocaine does not have major medical complications. In someone with delirium tremens, it is important to rule out other related problems such as electrolyte abnormalities, pancreatitis, and alcoholic hepatitis.
Prevention is by treating withdrawal symptoms. If delirium tremens occur, aggressive treatment improves outcomes. Treatment in a quiet intensive care unit with sufficient light is often recommended. Benzodiazepines are the drug of choice with diazepam, lorazepam, chlordiazepoxide, and oxazepam commonly used. They should be given until someone sleeps lightly. Haloperidol antipsychotics can also be used. Thiamine vitamins are recommended. Mortality without treatment is between 15% and 40%. Currently, death occurs in about 1% to 4% of cases.
About half of people with alcoholism will develop withdrawal symptoms after reducing their use. Of these, three to five percent develop DTs or have seizures. The name delirium tremens was first used in 1813; However, the symptoms were well described since the 1700s. The word "delirium" is Latin for "going from the groove," a plowing metaphor. This is also called trembling shaking syndrome and Saunders-Sutton. Nicknames include shakes, barrel-fever, blue horrors, bottleache, bats, drunken horrors, elephants, gallon distemper, quart mania, and pink spiders, among others.
Video Delirium tremens
Signs and symptoms
The main symptoms of delirium tremor are nightmares, agitation, global confusion, disorientation, visual and auditory hallucinations, tactile hallucinations, fever, high blood pressure, severe sweating, and other signs of autonomic hyperactivity (rapid heartbeat and high blood pressure). These symptoms may appear suddenly, but usually develop two to three days after quitting heavy alcohol, becoming the worst on the fourth or fifth day. Also, "these symptoms are characteristically worse at night". In general, DT is considered the most severe manifestation of alcohol withdrawal and occurs 3-10 days after the last drink. Other common symptoms include intense perceptive disorders such as insect vision, snakes, or mice. It may be hallucinations or environmental illusions, for example, patterns on wallpaper or in peripheral vision that patients misunderstand as morphology of insects, and are also associated with touch hallucinations such as the sensation of something crawling on the subject - a phenomenon known as formication. Delirium tremens usually include a very intense feeling of "impending doom". Severe anxiety and an imminent feeling of death are common DT symptoms.
DT can sometimes be associated with severe and uncontrollable tremors of extremities and secondary symptoms such as anxiety, panic attacks and paranoia. Confusion is often seen by the audience as those with DT will have difficulty forming simple sentences or making basic logical calculations.
DT should be distinguished from alcoholic hallucinosis, the latter occurring in about 20% of hospitalized alcoholics and not bringing significant deaths. In contrast, DT occurs in 5-10% alcoholic and carries up to 15% mortality with treatment and up to 35% mortality without treatment. DT is characterized by the presence of altered sensorium; ie, complete hallucination without acknowledgment of the real world. DT has extreme autonomic hyperactivity (high pulse, blood pressure, and respiratory rate), and 35-60% of patients have fever. Some patients experience seizures.
Maps Delirium tremens
Cause
Delirium tremens are mainly caused by periods of sudden terminated drinking. Withdrawal leads to a cascade of biochemical regulation. It can also be triggered by a head injury, infection, or illness in people with a history of heavy alcohol use.
Another cause of delirium tremens is the sudden cessation of sedative class barbiturates or benzodiazepines in someone with a relatively strong addiction to them. Because the pharmacological and physiological effects of these sedative primers come from the manipulation of GABA somatic chemical and transpiratory systems, the same neurotransmitter system is affected by alcohol, delirium tremens can occur in a sudden dose reduction in those who are highly dependent. This DT is almost the same as that caused by alcohol and so is the officer's withdrawal syndrome which is its manifestation. That is the main reason benzodiazepines are an effective treatment for DT, although it is also a cause in many cases. Because ethanol and tranquilizers such as barbiturates and benzodiazepines function as positive allosteric modulators in the GABA receptor A , the brain, in its desire to equalize unbalanced chemical systems, triggers a sudden cessation of endogenous GABA production. This decline is becoming more and more marked as the addiction becomes stronger and higher doses are required to cause poisoning. In addition to having tranquilizing properties, GABA is a very important regulatory neurotransmitter that controls heart rate, blood pressure, and seizure threshold among a myriad of other important autonomic nervous subsystems.
Delirium tremens are most common in people with a history of alcohol withdrawal, especially in those who drank the equivalent of 7 to 8 liters of US (3 to 4 liters) of beer or 1 liter of US (0.5 liters) of filtered beverages daily. Delirium tremens also often affect those who have a history of alcohol use habits or alcoholism that has existed for more than 10 years.
Pathophysiology
Delirium tremens are hypothesized alcohol withdrawal components as a result of compensatory changes in response to chronic alcohol abuse. Alcohol positively allosterically modulates the binding of GABA, resulting in disinhibition of neurons projecting into the nucleus accumbens, as well as inhibiting NMDA receptors. This is combined with the desensitization of alpha-2 adrenergic receptors, resulting in a homeostatic regulatory system that increases on chronic alcohol use. When alcohol use stops, unregulated mechanisms result in neuronal hyperexitability because natural GABAergic systems are unregulated glutamatergic systems and unregulated stimuli. This is combined with an increase in noradrenergic activity in delirium tremens symptoms.
Diagnosis
Diagnosis is primarily symptomatic. In someone with delirium tremens, it is important to rule out other related problems such as electrolyte abnormalities, pancreatitis, and alcoholic hepatitis.
Treatment
Delirium tremens because alcohol withdrawal can be treated with benzodiazepines. High doses may be needed to prevent death. The amount given is based on symptoms. Usually the person is anesthetized with benzodiazepines, such as diazepam, lorazepam, chlordiazepoxide, or oxazepam.
In some cases, antipsychotics, such as haloperidol may also be used. Older medications such as paraldehyde and clomethazole were once traditional treatments but are now largely replaced by benzodiazepines.
Acamprosate is sometimes used in addition to other treatments, and is then brought into long-term use to reduce the risk of relapse. If the status of epilepticus occurs, it will be treated in the normal way. It can also help control environmental stimuli, by providing a bright yet relaxing environment to minimize visual distress and hallucinations.
Alcoholic drinks can also be prescribed as a treatment for delirium tremens, but this practice is not universally supported.
High thiamine doses often with intravenous route are also recommended.
Society and culture
Nicknames include "horror", "shakes", "bottle bottle", "quart mania", "ork ork", "gallon distemper", "zoot", "barrel fever", "itching 750", "pint paralysis" saw the pink elephant. Another nickname is "Brooklyn Boys" which was found in acting one act of Eugene O'Neill in Hughie in the 1920 Times In Times.
Author Jack Kerouac details his experience with delirium tremens in his book Big Sur.
One of the characters in Joseph Conrad's novel Lord Jim has "DTs of the worst kind" with symptoms that include seeing millions of pink frogs.
In the 1945 film The Lost Weekend, Ray Milland won an Academy Award for Best Actor for his portrayal of characters who experience delirium tremor after being hospitalized, hallucinating that he saw a bat flying and eating a rat sticking out through the wall.
American writer Mark Twain described the episode of delirium tremens in his book The Adventures of Huckleberry Finn (1884). In Chapter 6, Huck declares about his father, "After dinner, drink the pap, and say he has enough whiskey there for two drunks and a delirium tremor. Next, Pap Finn runs with the hallucinatory snake and chases Huck around their cabin with a knife in an attempt to kill him, thinking Huck is the "Death Angel."
Episode M * A * S * H ​​â € <â € <(TV series) "Bottoms Up" (Season 9, Episode 15) shows a side story of a nurse (Cpt Helen Whitfield) who is known to drink alcohol while on duty. At the height of the episode, after a confrontation by Major Margaret Houlihan, the character left his alcohol and seemed to stop immediately. At mealtimes, an unspecified time (approx 48 hours, according to Major Houlihan), Whitfield becomes hysterical after being served food in the Mess tent, claiming that there were things that crawled on him from it. Margaret and Colonel Sherman Potter subdue it. Potter, after recognizing the symptoms of delirium tremens (which he abbreviated "DTs"), ordered 5 ml of Paraldehyde from the witnessing nurse.
Russian composer Modest Mussorgsky died of delirium tremens.
See also
- Alcoholic dementia
- Alcohol detoxification
- Delusional parasitosis
- Delirium Happy
- On the cart
References
External links
Source of the article : Wikipedia
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