Delirium tremens: Difference between revisions
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{{Redirect|The horrors|other uses|The Horrors (disambiguation)}} |
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{{Redirect|DTs|the acronym|DTS (disambiguation)}} |
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{{two other uses||the beer|Delirium Tremens (beer)|the Gold Rush town in California formerly with this name|Omega, California}} |
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{{Infobox Disease |Name=Delirium tremens |DiseasesDB=3543 |ICD10=F10.4 |ICD9={{ICD9|291.0}} |eMedicineSubj=med |eMedicineTopic=524 |MeshID=D000430}} |
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'''Delirium tremens''' ([[Latin language|Latin]] for "shaking frenzy", also referred to as '''The DTs''', "the horrors," "jazz hands," "giving the invisible man a handshake", "spirit fingers" or "the shakes.") is an acute episode of [[delirium]] that is usually caused by [[withdrawal]] from [[alcohol]], first described in 1813.<ref name=dt>{{cite web |url=http://emedicine.medscape.com/article/166032-overview |title=Delirium Tremens: eMedicine Critical Care |publisher= emedicine.medscape.com |year=2008 |accessdate=2009-06-23 |author=Michael Burns |coauthors=James Price & Michael E Lekawa}}</ref><ref name=gossman>{{cite web |url= http://emedicine.medscape.com/article/791802-overview |title=Delirium Tremens: eMedicine Emergency Medicine |year=2007 |publisher=emedicine.medscape.com |accessdate=2009-06-23 |last= Gossman |first=William}}</ref> [[Benzodiazepine]]s are the treatment of choice for delirium tremens (DT).<ref name="tx">{{cite web |url=http://emedicine.medscape.com/article/791802-treatment |title=Delirium Tremens: Treatment & Medication |publisher=emedicine.medscape.com |year=2007 |accessdate=2009-06-23 |last=Gossman |first=William}}</ref> |
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Withdrawal from sedative-hypnotics other than alcohol, such as benzodiazepines or [[barbiturate]]s, can also result in seizures, delirium tremens, and death if not properly managed. Withdrawal from other drugs which are not [[sedative-hypnotic]]s such as [[caffeine]], [[cocaine]], etc. does not have major medical complications, and is not life-threatening.<ref>{{cite book |last1=Galanter |first1=Marc |last2=Kleber |first2=Herbert D |title=The American Psychiatric Publishing Textbook of Substance Abuse Treatment |url= http://books.google.com/?id=6wdJgejlQzYC |edition=4th |date=1 July 2008 |publisher=American Psychiatric Publishing Inc |location=United States of America |isbn=978-1585622764 |page=58}}</ref> Withdrawal reactions as a result of physical dependence on alcohol is the most dangerous and can be fatal. It often creates a full blown effect which is physically evident through shivering, palpitations, sweating and in some cases, convulsions and death if not treated.<ref name="Healy2008">{{cite book|author=David Healy|title=Psychiatric Drugs Explained|url=http://books.google.com/books?id=ikTJViYMPIEC&pg=PA237|accessdate=30 November 2010|date=3 December 2008|publisher=Elsevier Health Sciences|isbn=9780702029974|pages=237–}}</ref> |
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When caused by alcohol, it occurs only in patients with a history of [[alcoholism]]. Occurrence of a similar syndrome due to [[benzodiazepine withdrawal syndrome|benzodiazepines]] does not require as long a period of consistent intake of such drugs. Benzodiazepines are relatively safe in overdose when taken alone; however, if the overdose includes the use of other sedative drugs, alcohol in particular, it could lead to dangerous side effects.<ref name="HalesPublishing2008">{{cite book|author1=Robert E. Hales|author2=American Psychiatric Publishing|title=The American Psychiatric Publishing textbook of psychiatry|url=http://books.google.com/books?id=2RzFWRIAsPAC&pg=PA396|accessdate=30 November 2010|year=2008|publisher=American Psychiatric Pub|isbn=9781585622573|pages=396–}}</ref> |
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In the U.S., fewer than about 50% to 60% of alcoholics will develop any significant withdrawal symptoms upon cessation of alcohol intake, and of these, only 5% of cases of acute [[alcohol withdrawal syndrome|ethanol withdrawal]] progress to DT.<ref name=dt/> Unlike the withdrawal syndrome associated with [[opiate]] dependence, DT (and alcohol withdrawal in general) can be fatal. Mortality was as high as 35% before the advent of intensive care and advanced [[pharmacotherapy]]; in the modern era of medicine, death rates range from 5-15%.<ref name=dt/> |
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Similar [[hyperirritability]] and hallucinosis can be caused by [[Hypomagnesemia|magnesium deficiency]].<ref>http://jama.ama-assn.org/content/174/1/77.extract The Clinical Expression of Magnesium Deficiency</ref> |
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==Symptoms== |
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The main symptoms of Delirium Tremens are confusion, diarrhea, insomnia, disorientation and agitation and other signs of severe [[autonomic nervous system|autonomic]] instability ([[fever]], [[tachycardia]], [[hypertension]]).<ref name=DTAbout>[http://internal-optimist.blogspot.com/2010/01/alcohol.html A UK medical student blog], Information on DT and alcohol withdrawal, retrieved on January 25, 2009.</ref> These symptoms may appear suddenly but can develop 2–3 days after cessation of drinking heavily with its highest peak/ intensity on the fourth or fifth day.<ref>Hales R., Yudofsky S., and Talbott J. 1999 Textbook of Psychiatry 3rd Ed. London: The American Psychiatric Press.</ref> Also, these "symptoms are characteristically worse at night".<ref>Gelder et al, 2005 p188 Psychiatry 3rd Ed. oxford:New York.</ref> Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats. These may be hallucinations, or illusions related to the environment, e.g., patterns on the wallpaper or in the peripheral vision that the patient falsely perceives as a resemblance to the morphology of an insect. Unlike hallucinations associated with [[schizophrenia]], delirium tremens hallucinations are primarily visual, in the peripheral field of vision, but are also associated with tactile hallucinations such as sensations of something crawling on the subject — a phenomenon known as [[formication]]. Delirium Tremens usually includes extremely intense feelings of "impending doom". Severe anxiety and feelings of imminent death are at the foundation of DT. |
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DT can sometimes be associated with severe, uncontrollable [[tremor]]s of the extremities and secondary symptoms such as anxiety, panic attacks and [[paranoia]]. Confusion is often noticeable to onlookers as patients will have trouble constructing simple sentences or making basic logical calculations. In many cases, people who rarely speak out of turn will have an increased tendency for gaffes even though they are sober. |
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DT should be distinguished from [[alcoholic hallucinosis]], the latter occurring in approximately 20% of hospitalized alcoholics and not carrying a significant mortality. In contrast, DT occurs in 5-10% of alcoholics and carries up to 5% mortality with treatment and up to 35% mortality without treatment.<ref name=gossman/> DT is characterized by the presence of altered [[sensorium]]; that is, a complete hallucination without any recognition of the real world. DT has extreme autonomic hyperactivity (high pulse, blood pressure, and rate of breathing), and 35-60% of patients have a fever. Some patients experience [[seizure]]s. |
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==References== |
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{{reflist}} |
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==External links== |
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{{Portal|Psychiatry}} |
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* [http://www.nlm.nih.gov/medlineplus/ency/article/000766.htm Medline Encyclopedia: Delirium Tremens] |
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* [http://www.emedicine.com/EMERG/topic123.htm eMedicine Delirium Tremens] |
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{{Psychoactive substance use}} |
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{{Alcohealth}} |
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{{DEFAULTSORT:Delirium Tremens}} |
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[[Category:Alcohol abuse]] |
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[[Category:Addiction psychiatry]] |
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[[Category:Neurological disorders]] |
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[[Category:Latin medical phrases]] |
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[[Category:Medical emergencies]] |
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[[Category:Mental and behavioural disorders]] |
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[[cs:Delirium tremens]] |
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[[et:Delirium tremens]] |
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[[es:Delírium trémens]] |
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[[eu:Delirium tremens]] |
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[[fr:Delirium tremens]] |
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[[hi:डेलेरियम त्रेमेंस]] |
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[[hr:Delirium tremens]] |
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[[la:Delirium tremens]] |
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[[hu:Delirium tremens]] |
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[[nl:Delirium tremens (ontwenningsverschijnsel)]] |
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[[nn:Delirium tremens]] |
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[[pl:Majaczenie alkoholowe]] |
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[[pt:Delirium tremens]] |
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[[ro:Delir]] |
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[[ru:Алкогольный делирий]] |
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[[simple:Delirium tremens]] |
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[[sl:Alkoholni delirij]] |
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[[sr:Делиријум тременс]] |
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[[fi:Delirium tremens]] |
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[[sv:Delirium tremens]] |
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[[tr:Deliriyum tremens]] |
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[[uk:Біла гарячка]] |
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