Delirium tremens: a severe alcohol withdrawal syndrome

Throughout history, society has assimilated the consumption of alcoholic beverages, Become a feature of some cultures. This is something that can be observed in parties, concerts and nightclubs, traditions, as part of the leisure habits of youth and even in the popularity of such phenomena as botellons.

However, it should be borne in mind that the consumption of alcohol can be addictive as the drinker loses control of the consumption so that addiction to the substance is generated. And this addiction is expressed not only through substance abuse, but also through the signs and symptoms that appear when you stop drinking alcohol. Among the most serious phenomena of abstinence delirium tremens. Let’s see what it is.

The mechanics of abstinence

Once a dependency has been generated, removing the object on which it is dependent causes withdrawal syndromeThat is, the absence of the substance in the body causes symptomatic reactions. That is why, in many cases, stopping alcoholism is not as simple as removing the possibility of consuming this type of drink once and for all. Lack of this substance also produces a number of symptoms which can sometimes be dangerous in themselves.

The opposite effect is usually caused by the substance, which means that in the case of a depressive substance (such as alcohol) manic-like symptoms will occur, while in the case of stimulants the syndrome will occur. abstinence will consist of a decrease in the general activity of the body. In all cases **, withdrawal of the desired substance must be controlled **, as too sudden an interruption in the supply can cause these syndromes.

Among the withdrawal syndromes linked to alcohol abuse, the most serious is delirium tremens.

What is delirium tremens?

This is called delirium tremens al acute confusing image produced by alcohol deprivation. It is caused by discontinued alcohol consumption in chronic drinkers who have developed a physical dependence and frequently appears after 4 to 72 hours of abstinence.

While delirium tremens usually occurs in patients who stop drinking after excessive alcohol consumption, it is possible to find cases where this syndrome was caused by illness, trauma or infection in people with strong alcohol consumption.

Symptoms of delirium tremens

The main symptoms of this syndrome are a disintegration of consciousness in which visual hallucinations, delusions, emotional lability and stupor appear. Tremor, restlessness and convulsions are also common.

Usually, delirium tremens has a short duration, but despite this, it is a dangerous syndrome, as 20% of cases are fatal if they do not receive medical attention, and even with this 5% of cases it is end with the death of the patient.

Phases of delirium tremens

In a first phase, vegetative symptoms such as anxiety, tachycardia, dizziness, restlessness and insomnia, caused by an increase in norepinephrine in the blood, begin to be observed. If the second phase is reached, approximately 24 hours after its onset, the intensity of the above symptoms increases, with uncontrollable tremors and heavy sweating. Seizures can also occur.

Finally, in the third phase (defining delirium tremens), a state of altered consciousness called clouding appears. It is defined by a propensity for distractions and confusion, accompanied by a deep disorientation. The most characteristic of this phase is the appearance of visual hallucinations (usually microzoopsies) and delusions, accompanied by a strong feeling of anxiety. There is also restlessness, tachypnea, hyperthermia and tachycardia.

possible treatments

Since delirium tremens is a problem that can lead to the death of the patient, immediate hospitalization of people with the symptoms described is necessary, and it may be necessary to enter the ICU.

The basic objectives of the treatment to be applied will be to keep the patient alive, to avoid complications and to alleviate symptoms. Thus, monitoring of those affected was constant, observing their hydroelectric balance and vital signs.

Although the specific measures will depend on the case, administration of diazepam, lorazepam and dipotassium chlorazepat to achieve sedation of the patient, fluid electrolyte control to maintain hydration of the affected person and vitamins to maintain proper functioning of the patient. the body. Likewise, haloperidol is also often used to control the psychotic process and hallucinations.

One last consideration

While binge drinking is a dangerous phenomenon, and those who stop drinking are doing so for good reasons, those who decide to stop drinking should consider the physical dependence their bodies maintain. with respect to this substance.

It is essential with addiction or substance use for a prolonged period (including drugs such as tranquilizers or antidepressants) that the withdrawal of the substance be done gradually, because in the early stages the body needs of a certain dose of the substance to continue to function properly.

Also, keep in mind that the type of health risks associated with delirium tremens can be avoided. detect cases of alcohol dependence in time, Which makes it possible to close the passage in time to alcoholism. The use of this type of drink is socially widely accepted and widespread in all kinds of settings, which is why the detection of its first signs can be complicated, given the degree of normalization of the abuse of these substances.

To know some of the clues that indicate the presence of the onset of alcoholism, you can read this article: “The 8 Signs of Alcohol Addiction”.

Bibliographical references:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Straps, J .; Ramirez, A. and Chinchilla, A. (2003). Psychiatric Emergency Manual. Masson.
  • Ferri, FF (2015). Delirium tremens. R: Ferri FF, ed. Clinical advisor Ferri. 1st ed. Philadelphia: PA Elsevier Mosby; p. 357.
  • Golberg, D. and Murray, R. (2002). Maudsley’s book on practical psychiatry. Oxford.
  • Marta, J. (2004). Practical approach to delirium. Masson.
  • O’Connor, PG (2016). Alcoholic disorders. A: Goldman L, Schafer AI, eds. Goldman’s Medicine Cecil. 25th ed. Philadelphia, PA: Elsevier Saunders; chap 33.

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