Articles: alcohol-withdrawal-delirium.
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Acta Psychiatr Scand · Oct 1980
Stepwise regression analysis of an intensive 1-year study of delirium tremens.
An intensive 1-year study was carried out on 41 male patients, mean age 49, mean hospitalization time 49 days, admitted to a special ward of the Beckomberga Hospital with the diagnosis of delirium tremens and 50 concomitant somatic and psychiatric diagnoses (1--9 per capita), and given a standardized treatment. The mean duration of delirium tremens after admission was 2 days; 76% recovered within 48 h. The duration after admission was positively correlated to age, number of previous delirium tremens, negatively correlated to B-haemoglobin and B-haematocrit for laboratory data obtained within the first 24 h and was positively correlated to blood sugar and S-creatinine on data taken within 40 h (Pearson correlation matrix). ⋯ In view of this knowledge, it is reasonable to assume that the lack of statistical significance is due to the small sample size rather than to the alternative that no explanation is offered by S-magnesium. Furthermore, B-haemoglobin, S-potassium, S-ASAT, and S-ALAT, known to be characteristically altered in delirium tremens, were found on forcing (a variant of SWR) to be of secondary importance to S-magnesium as explaining factors, whereas blood sugar and S-creatinine derived part of their explaining power from S-magnesium. In conclusion, extensive use of SWR analysis based on 46 potential explaining variables points to serum magnesium concentration as the most important factor in predicting the duration of delirium tremens.
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Withdrawal from alcohol (ethanol, ethyl alcohol) or other general sedatives leads to progressive hyperactivity that progresses from tremulousness, sleep disturbance, and hallucinosis, to the more serious rum fits and delirium tremens (DTs). Withdrawal can be prevented and, in most cases, arrested by prompt replacement of alcohol with paraldehyde, benzodiazepines or other general sedatives. Diazepam is appropriate replacement therapy for most patients. ⋯ The patient with DTs must be calmed with a general sedative that has a rapid onset of maximal effect to prevent overdosage. Diazepam, 5 mg intravenously every five minutes, permits evaluation of the maximal effect of each dose before the next dose is administered. Although some patients have advance sedative or alcohol withdrawal, great care must be taken to elicit the proper history of alcohol abuse so that sedative replacement therapy will prevent or abort early withdrawal, thus sparing the patient a mortality equivalent to that of acute myocardial infarction or Russian roulette.