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At least 19 recordsLinked to original sources
PubMed1993

Intravenous flunitrazepam in the treatment of alcohol withdrawal delirium.

Alcohol withdrawal delirium (AWD) requires treatment with an adequate sedative, anticonvulsant, and antipsychotic agent next to general intensive care measures. Optimal medication should have a rapid onset of action and the possibility of parenteral application. A specific antagonist should be available. Flunitrazepam is a benzodiazepine that fulfills all these criteria. Twenty five patients suffering from AWD (mean age 45 years) took part in an open trial and underwent treatment with infusions of flunitrazepam (concentration: 8 mg/250 ml NaCl; speed, 250 ml/hr). Psychopathological, vegetative, and vital parameters were assessed every hour. All patients survived. They were treated with a mean total dose (SD) of 83.9 (45.4) mg of flunitrazepam (1.3 mg/kg body weight), which induced sedation 13.2 (5.3) min after the initiation of intravenous treatment. The mean duration of AWD (85.1 +/- 39.4 hr) corresponded to other studies, whereas the frequency of preexisting and concomitant diseases was higher (92%) in our patients. A patient who suffered from bronchitis and had a nasopharyngeal tamponade showed severe respiratory depression after having received 4 mg of flunitrazepam. This complication remitted immediately when 0.5 mg of flumazenil was given intravenously. No epileptic manifestation was observed during the treatment or after discontinuation of flunitrazepam. Vegetative and psychopathological symptoms (tremor, sweating, hallucinations, confusion, and restlessness) remitted rapidly. Our data suggest that intravenous flunitrazepam can be an efficacious and safe alternative to traditional treatment strategies of AWD.

Adult↗
PubMedDate not supplied

Protracted alcohol withdrawal delirium.

Protracted alcohol withdrawal delirium is infrequent, but when it occurs significant morbidity can be anticipated. In this report, a case of protracted alcohol withdrawal delirium is presented. The patient's course was complicated by intracerebral and subdural hemorrhages, sedative-hypnotic drug synergism resulting in respiratory compromise, the failure of benzodiazepines to prevent delirium or shorten its duration, and the onset of Wernicke's encephalopathy.

Alcohol Withdrawal Delirium↗
PubMed1994

Circadian variations in plasma monoamine metabolites level in alcoholic patients: a possible predictor of alcohol withdrawal delirium.

1. Alcohol withdrawal symptoms in 17 alcoholics were classified into two groups according to the severity of their symptoms, and circadian variations in their plasma 5-hydroxyindoleacetic acid (5HIAA) and homovanillic acid (HVA) levels during the alcohol withdrawal and the abstention periods were compared with those in normal controls by two-way ANOVA. 2. Circadian variations in plasma 5HIAA level in alcoholic patients manifested severe alcohol withdrawal symptoms and exhibited phase advances in both the withdrawal and the abstention periods and significantly higher levels in the abstention period. 3. Circadian variation in plasma HVA in the abstention period in alcoholics showed severe withdrawal symptoms demonstrating significantly higher levels compared with normal controls. 4. These findings suggest that the serotonergic and dopaminergic activity may vary depending on the severity of alcohol withdrawal symptoms and the measurement of circadian variations in plasma 5HIAA and HVA levels could possibly be used as a predictor of hardly predictable alcohol withdrawal delirium.

Adult↗
PubMed2003

[Adjuvant therapy with parenteral piracetam in alcohol withdrawal delirium].

The author reports his results of parenteral piracetam treatment in 193 patients admitted to the Psychiatric Department of Semmelweis Hospital with alcohol withdrawal delirium. Alcohol withdrawal delirium is a complex metabolic disorder, the disturbance of the highest cerebral integrative functions, which is caused by the impairment of cerebral oxidative metabolism. Piracetam is effective on most neurotransmitter systems, without a specific receptor agonism or antagonism, increases the effectivity of different biogenic amine systems, has also an effect on membrane permeability, increases the concentration of NMDA (methyl-D-aspartate) receptors in the impaired brain and improves cognitive functions. In the patients suffered from alcohol dependence piracetam produces positive morphologic changes, by decreasing lipofuscin accumulation. In early stage it prevents the development of delirium. Despite of the great number (approximately 150) of medication that were tried in the treatment of delirium, the ideal one still has not been found. Among the accessible therapeutic possibilities the author searched for methods which make the treatment more effective. The administration of parental piracetam, therefore was brought into his therapeutical protocol. Parenteral piracetam--similarly to literature data--proved to be effective in the treatment of alcohol withdrawal delirium. Considering the present--insufficient--hospital financing, it is remarkable that though the costs of the new therapy are higher than the traditional meprobamat therapy, through less side effect it is more economical (overall costs lower) and by decreasing the time of delirium it is more humane to the patients.

Adult↗
PubMed2004

Management of alcohol withdrawal delirium. An evidence-based practice guideline.

BACKGROUND: Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal. Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable. METHODS: Articles with original data on management of alcohol withdrawal delirium underwent structured review and meta-analysis. RESULTS: Meta-analysis of 9 prospective controlled trials demonstrated that sedative-hypnotic agents are more effective than neuroleptic agents in reducing duration of delirium and mortality, with a relative risk of death when using neuroleptic agents of 6.6. Statistically significant differences among various benzodiazepines and barbiturates were not found. No deaths were reported in 217 patients from trials using benzodiazepines or barbiturates. CONCLUSIONS: Control of agitation should be achieved using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol. Adequate doses should be used to maintain light somnolence for the duration of delirium. Coupled with comprehensive supportive medical care, this approach is highly effective in preventing morbidity and mortality.

Alcohol Withdrawal Delirium↗
PubMed2000

[Diagnostic and prognostic value of additional neurologic diagnosis in alcohol withdrawal delirium].

A severe course of alcohol withdrawal has been observed in 28% of patients in a neurological intensive care unit due to complicating central nerve system (CNS) diseases. In any atypical alcoholic delirium, especially with focal neurological signs, partial seizures, or decreased level of consciousness, CNS diseases like meningoencephalitis, intracranial hemorrhage, or central pontine myelinolysis must be diagnosed by computed tomography (CT) scan and cerebral spinal fluid (CSF) tap. The diagnostic and prognostic value of CT scan and CSF analysis was examined in 32 persons with alcohol withdrawal syndrome or delirium tremens. Neurological complications and cerebral convulsions at the beginning of delirium tremens appear to predispose the patient to a protracted clinical course and necessary mechanical ventilation. Blood-CSF barrier permeability is increased in 70% of alcohol withdrawal patients and that also seems to be a marker of a prolonged clinical course. Cerebral atrophy as shown in CT scan does not play a role in predicting clinical course. In our experience, CT examination or lumbar puncture is not necessarily recommended if clinical signs are typical for alcohol delirium.

Adult↗
PubMed2001

A model for predicting alcohol withdrawal delirium.

OBJECTIVE: The aim of this study was to develop a model for identifying patients with a high risk of developing alcohol withdrawal delirium after assessment in the emergency department. METHODS: Patients seeking acute treatment for alcohol withdrawal at St. Göran's hospital in Stockholm were evaluated for known risk factors for alcohol withdrawal delirium. All patients with any risk factor were admitted to the hospital and received standard treatment with benzodiazepines. All patients were evaluated at admission by the physician in charge at the psychiatric and dependency emergency unit at the hospital. Treatment and final assessment were conducted at the unit's inpatient acute-treatment facility. Correlations were determined between risk factors noted at admission and development of alcohol withdrawal delirium, as defined in DSM-IV, after admission. A total of 334 alcohol-dependent patients were included in the study. RESULTS: Twenty-three patients, or 6.9 percent, developed alcohol withdrawal delirium after admission despite benzodiazepine treatment. In a stepwise multiple regression model, five risk factors were significantly correlated with the development of alcohol withdrawal delirium: current infectious disease; tachycardia, defined as a heart rate above 120 beats per minute at admission; signs of alcohol withdrawal accompanied by an alcohol concentration of more than 1 gram per liter of body fluid; a history of epileptic seizures; and a history of delirious episodes. No patient without these five risk factors developed delirium. CONCLUSION: Assessment for five easily detectable risk factors can enable the clinician to make an accurate and quantitative assessment of a patient's risk of developing alcohol withdrawal delirium.

Alcohol Withdrawal Delirium↗
PubMed1999

The role of somatic disorders and physical injury in the development and course of alcohol withdrawal delirium.

In a retrospective study, we evaluated the role of somatic disease and physical injury in the development and course of alcohol withdrawal delirium. Medical records of 1179 patients treated for alcohol withdrawal in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Development, symptoms' severity, and the course of alcohol withdrawal delirium were assessed in possible relation to the somatic state of patients and other variables of alcohol dependence. Development of the first episode of delirium tremens (DT) was associated with the incidence of somatic disease or injury in 19% of cases. Somatic disorders directly preceded the second episode of DT in 73% and the third in 57% of cases. A positive correlation was found between the greater severity and/or longer duration of DT symptoms, and occurrence of pneumonia, coronary heart disease, alcohol liver disease, and anemia, as well as daily amount of alcohol consumed during the last drinking bout. There was no relationship of severity of DT with the duration of alcohol abuse. Early development and severe course of alcohol withdrawal delirium correlated with the late beginning of excessive drinking (over the age of 40) and concomitant abuse of benzodiazepines or barbiturates. We concluded that somatic disorders or physical injury might trigger delirium during alcohol withdrawal, and have essential influence on the symptoms' severity and duration of DT. A more severe course of DT is also correlated with the quantity of alcohol consumed and concomitant abuse of sedatives.

Adolescent↗
PubMed1989

[Electrolyte disorders, EEG changes and epileptic seizures in alcohol withdrawal delirium].

For 180 patients suffering alcohol-withdrawal induced delirium, electrolytic concentration in the serum of Na, K, Ca, and Mg was determined in the early withdrawal phase, and the electroencephalograms of 95 delirium patients evaluated in respect of local and diffuse changes and epileptic activity, and compared in delirium patients with and without initial seizures. Delirium patients who had initial seizures suffered significantly longer-lasting periods of delirium and significantly more frequent electrolytic changes in the form of hypomagnesemia and hypopotassemia (hypokalemia). There was no significant difference in the EEG changes. A temporary metabolic disorder in the initial phase of the two-phase withdrawal process should be assumed to be the cause of seizures during alcohol withdrawal, and the pathogenetic significance of hypomagnesemia and hypopotassemia should be taken into consideration.

Alcohol Withdrawal Delirium↗
PubMed1994

[Treatment alternatives of alcohol withdrawal delirium].

The choice of treatment in alcohol withdrawal syndromes (clomethiazole, benzodiazepines, neuroleptics or clonidine) is still a subject of dispute. After administration of ethanol, the CNS shows significant short and long-term changes in a number of transmitter-systems (e.g. noradrenaline, GABA, glutamate, dopamine), which--at least partially--explain the variety of symptoms in alcohol withdrawal and may indicate a correlation between the symptoms and the transmitter systems affected. An optimal drug would have to meet a wide range of criteria, combining good antiadrenergic, anticonvulsive and antipsychotic properties with a high margin of therapeutic safety and good controllability. With respect to monotherapy, clomethiazole and to a lesser degree also benzodiazepines are most likely to fulfil these criteria, both theoretically and in the light of comparative studies. Combined therapy has some advantages in theory, but is not yet backed by sufficient empirical evidence. We recommend a graduation of therapy according to the severity of withdrawal symptoms, starting with adjuvant measures and orally administered clomethiazole, while i.v. application of clomethiazole on an ICU is necessary in fully developed delirium tremens. Additional therapy with potent neuroleptics is reasonable, if psychotic symptoms persist. Other combinations may be applied in individual cases according to the prevailing symptoms.

Alcohol Withdrawal Delirium↗
PubMed2006

Valproic acid management of acute alcohol withdrawal.

OBJECTIVE: To review the clinical evidence to determine the efficacy and safety of valproic acid in the management of alcohol withdrawal syndrome (AWS). DATA SOURCES: MEDLINE (1966-February 2006), EMBASE (1980-February 2006), and PubMed (1966-February 2006) searches identified pertinent studies that were conducted in humans and published in English. Key words used for identification of articles included valproic acid, ethanol, alcohol, alcoholism, alcohol withdrawal delirium, alcohol withdrawal seizures, and substance withdrawal syndrome. References of identified articles were manually searched. STUDY SELECTION AND DATA EXTRACTION: All controlled clinical trials that evaluated the use of valproic acid for the management of AWS in humans were included. DATA SYNTHESIS: Comparisons were made among various regimens of valproic acid and traditional therapy with benzodiazepine or nonbenzodiazepine agents. Only 2 of 6 trials reported a statistically significant difference in favor of valproic acid on endpoints of AWS. However, these differences were of marginal clinical significance. The number of patients included in these studies did not allow for adequate evaluation of safety. CONCLUSIONS: The existing limited efficacy and safety data suggest that valproic acid should not replace conventional therapy or be used as adjunct therapy for management of mild-to-moderate AWS.

Alcohol Withdrawal Delirium↗
PubMed2003

[Can alcoholic withdrawal delirium be prevented?].

In alcohol-dependent in-patients, an adequate drug prophylaxis should be made in order to lower the degree of a developing alcohol withdrawal syndrome (AWS) or to prevent a life-threatening delirium tremens. Pre-condition of successful therapy is a precise diagnosis. In patients, the beginning of whose abstinence is known, carefully-targeted pharmacological interventions can prevent severe imbalances of neurotransmitters. Typical time courses of destabilisation of neural balances should be considered. Since there is no single drug which is able to influence various transmitter systems, normally the use of drug combinations is necessary. In ENT-patients, traumatologic patients and patients from the department of maxillo-facial surgery, screening methods based on a simply-structured questionnaire relating to information from the patient and his surroundings and selected laboratory parameters should be used. High-risk patients who could get an AWS or delirium tremens should be treated prophylactically during their oral premedication period. Important drugs for successful prophylaxis of an AWS are benzodiazepines, clonidin, magnesium and vitamin B 1. A close-meshed control of the glucose metabolism, electrolyte and acid-base balance should be performed. Neuroleptica can be used if there is any indication for their adjuvant use. In severe cases that require deep sedation or hypnosis, propofol or gamma-hydroxy-butyric acid should be used. Perioperative infusion of alcohol as a prophylactic agent against delirium tremens is regarded as an obsolete therapeutic measure for ethical reasons and because equally good or better results can be achieved by carefully-targeted drug therapy. Due to its easy use, however, the application of alcohol has not yet completely disappeared from the therapeutic spectrum.

Alcohol Withdrawal Delirium↗
PubMed1998

Possible allelic association of a tyrosine hydroxylase polymorphism with vulnerability to alcohol-withdrawal delirium.

Recently, an association has been reported between schizophrenia and a rare allele containing 10-repeats (A10) of a polymorphic tetranucleotide motif in the first intron of the tyrosine hydroxylase (TH) gene. The present association analysis tested the hypothesis that the A10 candidate allele confers vulnerability to alcohol-withdrawal delirium with visual hallucinations. The genotype of the TH tetranucleotide polymorphism was assessed in 204 German controls and 311 German alcohol-dependent subjects, including 63 alcoholics with a history of visual hallucinations during withdrawal delirium. The frequency of the A10 allele was significantly increased in the alcoholics with withdrawal delirium (3.2%) compared with that in the controls (0.5%; Fisher's exact test: P = 0.03, two-tailed; OR (A10+) = 6.85, 95% confidence interval: 1.52-30.79). The possible allelic association suggests that allelic variation at the TH locus mediates vulnerability to alcohol-withdrawal delirium in a small proportion of alcohol-dependent subjects.

Adult↗
PubMed1982

[Therapy of alcohol withdrawal delirium with a new hypnotic].

The treatment of alcohol withdrawal symptoms which suddenly appear after an operation, is discussed. Therapy with etomidate as long term sedation is described. 500 mg of etomidate (125 mg circumflex or equal to 1 ml) soluted in 50 ml physiological saline was given by perfusor (0.6 - 0.8 mg/kg b.w./h). Therapy-time lasted from 48 - 56 hours. The influence on respiration, circulation and laboratory report was investigated. We discuss the comparison in the advantage and disadvantage of this therapy to other medications.

Adult↗