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DT
DT
About 50% of persons with AUD (13 -71%) have symptoms of alcohol withdrawal
Rate of DT varies from 5% to 10% in those with symptoms of alcohol withdrawal
Rate of alcohol-withdrawal seizures is estimated at between 2-9%
30% of untreated patients go on to develop DT
During any stage of the alcohol withdrawal, transient hallucinations either visual or
tactile may occur in 3-10% of patients with severe withdrawal; no prognostic
significance
RECOGNIZING DELIRIUM TREMENS
Severity Mild withdrawal Moderate withdrawal Severe withdrawal Delirium tremens
Clinical features Mild anxiety, Moderate severity of all Increased severity of all Hyperkinetic delirium
restlessness, insomnia, the symptoms the symptoms with marked confusion,
tremor, sweating, mild mentioned in mild mentioned in moderate disorientation &
headache withdrawal & withdrawal & mild agitation, severe
photosensitivity, pins confusion, autonomic tremors, severe
and needles sensation, symptoms and/or autonomic instability,
sensitivity to sounds withdrawal seizures hyperpyrexia, frank
hallucinations
Time since last drink 6 hours 6-24 hours 24-48 hours 48-72 hours
Hyperkinetic delirium
Tremors
Autonomic storm
Hallucinations
• Mild symptoms appear 6-8 hours after abrupt cessation or reduction of drinking; in
the majority withdrawal syndrome is short-lived & limited to such minor symptoms,
which generally resolve well within 5 days with minimal or no medical treatment
• In others withdrawal symptoms escalate in severity over the first 48 to 72 hours of
the last drink culminating in the DT, or other severe withdrawal states such as
seizures and hallucinations
• Prompt recognition
• Appropriate pharmacotherapy
(Protocol-driven management with monitoring on the
CIWA-Ar or other scales)
• Supportive measures
MANAGING DT
Goals of treatment
• Fixed-schedule dosing
• Symptom-triggered
• Loading
• Bolus dose of 10-30 mgs diazepam equivalent every 5-10 minutes until
light sedation (drowsy but verbally responsive) is achieved or CIWA-Ar
scores are < 8
• Then 5 -20 mg every hour as maintenance; monitoring with CIWA-Ar every
10 minutes for first hour & every 2 hrs once stable along with monitoring of
vitals
• Initial treatment-duration 1-2 hours following which medications are tapered
over 72 hours & a less intensive medication regimen substituted
FRONT LOADING
REFRACTORY DT