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Delirium Tremens

Delirium tremens is a disorder involving sudden and severe mental changes (psychosis) or neurologic changes (including seizures) caused by abruptly stopping the use of alcohol. Rapid pulse rate, elevated blood pressure, and temperature elevation also may be present.

Causes

Delirium tremens can occur after a period of heavy alcohol drinking, especially when the person does not eat enough food. It may also be triggered by head injury, infection, or illness in people with a history of heavy use of alcohol. It is most common in people who have a history of alcohol withdrawal , especially in those who drink the equivalent of 7 - 8 pints of beer (or 1 pint of "hard" alcohol) every day for several months. Delirium tremens also commonly affects those with a history of habitual alcohol use or alcoholism that has existed for more than 10 years. Symptoms occur because of the toxic effects of alcohol on the brain and nervous system. They may be severe and get worse very quickly.

Symptoms

Tremors (shakes) — These usually begin within 5 to 10 hours after the last alcohol drink and typically peak at 24 to 48 hours. Along with tremors (trembling), you can have a rapid pulse, an increase in blood pressure, rapid breathing, sweating, nausea and vomiting, anxiety or a hyper-alert state, irritability, nightmares or vivid dreams, and insomnia.

Alcohol hallucinosis — This symptom usually begins within 12 to 24 hours after your last drink, and may last as long as 2 days once it begins. If this happens, you hallucinate (see or feel things that are not real). It is common for people who are withdrawing from alcohol to see multiple small, similar, moving objects. Sometimes the vision is perceived to be crawling insects or falling coins. It is possible for an alcohol withdrawal hallucination to be a very detailed and imaginative vision.

Diagnosis

The diagnosis of alcoholism can either be based on medical and/or psychological conditions. With a long-term history of abusive drinking, medical conditions can result, and these could lead the physician to suspect a patient's alcoholism. These medical conditions may include organ complications such as: cirrhosis (liver), hepatitis (liver), pancreatitis (pancreas), peripheral neuropathy (nervous system) or cardiomyopathy (heart). Additionally, recurrent trauma, resulting in bone fractures, fatigue, depression, sexual dysfunction, fluctuating blood pressure, and sleep disorders may prompt the clinician to further assess for alcoholism.

Treatment

In persons with hallucinations, cautious use of antipsychotic medications such as haloperidol may be necessary in some cases.

Long-term preventive treatment may begin after the patient recovers from acute symptoms. This may involve a "drying out" period, in which no alcohol is allowed. The person should receive treatment for alcohol use or alcoholism, including counseling, support groups (such as Alcoholics Anonymous), and other behavior modifications.

Seizures and cardiovascular conditions, such as heart arrhythmias, are treated as appropriate. This may include lifesaving or life-support measures, anticonvulsant medications such as phenytoin, or other medications. Clonidine may reduce cardiovascular symptoms, and helps reduce anxiety. Central nervous system depressants and sedatives may be required, often in large doses, to reduce symptoms.

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