Delirium tremens

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Classification according to ICD-10
F10.4 Mental and behavioral disorders due to alcohol
ICD-10 online (WHO version 2019)

The delirium tremens (from Latin delirium , insanity ',' delirium ', and tremere tremble'; synonym alcoholic delirium ) poses a serious and potentially life-threatening complication in a long-standing alcoholism . Is It occurs mostly in the context of alcohol withdrawal on, but can are also less likely to be triggered by alcohol intoxication itself. Delirium tremens can also occur with other addictions in withdrawal or as a direct side effect. The term is usually only used for the full picture of alcohol withdrawal.

A delirium is an organic psychosyndrome that is characterized by disturbances of consciousness and attention , perception, thinking, memory, psychomotor skills , emotionality and the sleep-wake rhythm that occur at the same time . The duration varies, and the severity ranges from mild to fatal.

Epidemiology

Lifetime prevalence : 5% (2 to 15%) of all alcohol-dependent people, risk of recurrence 12 to 23%. The risk of developing delirium tremens during alcohol withdrawal is less than 1%.

course

Spontaneous course: The mortality (mortality rate) of untreated delirium is 25%, with older and repeatedly delirious patients having a poorer prognosis, mainly due to their multimorbidity . For the remaining cases, recovery occurs after three to five days (max. 20 days). Anxiety, sleep disorders and mild vegetative complaints can persist for up to six months, however, and lead to the alcoholic relapsing in the sense of self-therapy, i.e. drinking alcohol again to get rid of these symptoms.

Approx. 50% of all alcohol deliria are initiated by epileptic seizures (i.e. mostly in the predelirium), but these are often misunderstood as an alcoholic twilight state .

Deliria, which occur in the context of other alcohol-related diseases such as pancreatitis , upper gastrointestinal bleeding in liver cirrhosis or pneumonia, are not uncommon . If the patient is admitted to hospital because of these illnesses and no longer receives alcohol there, delirium can be an aggravating factor in addition to the admission illness. This also applies to impaired consciousness after accidents, especially after traumatic brain injuries .

Symptoms (signs of illness)

The clinical symptoms are composed of:

Psychiatric symptoms
Fear, local, temporal and situational disorientation, illusionary misunderstandings , hallucinations (mostly optical), sometimes pronounced suggestibility, mostly with a relationship to alcohol
Example: The person concerned sees animals or other things that are not real.
Neurological symptoms
Confusion with varying degrees of consciousness up to coma ; Restlessness, fine to very coarse tremors (called tremor); tonic and clonic convulsions
Vegetative symptoms
Profuse sweating , increase in pulse, blood pressure and breathing rate. Particularly in the case of untreated courses, lethal vegetative derailments can occur. If therapy is initiated in good time, the rate of fatal courses drops significantly.

Division into degrees of severity

Incomplete delirium (so-called predelirium), complete delirium (the actual delirium tremens), life-threatening delirium.

diagnosis

This is established “clinically”, i.e. through observation, physical examination and above all through personal and third-party anamnesis (attention: dissimulation , including false information by relatives as a result of feelings of shame). The diagnosis can also be made ex juvantibus . Alcohol is administered orally or through the vein. Symptoms disappear within minutes, especially when given via the vein. In fully developed delirium, however, no alcohol is given. Instead, drug treatment with benzodiazepines or "Distraneurin®" = clomethiazole is started. B. clonidine or haloperidol can be used (see treatment).

Differential diagnosis

treatment

  • An impending or already developed delirium requires immediate emergency hospitalization.
  • If the disease is full, treatment in an intensive care unit is advisable.
  • The most important immediate measure is the monitoring of the vital parameters. In addition, close laboratory controls should take place:
  • Since the patients are often aggressive, restless and sometimes psychotic, treatment with sedatives is necessary.
  • Benzodiazepines or clomethiazole are used as basic therapeutic agents. For this purpose, other substances are often given symptom-oriented, such. B. Haloperidol (side effects, in particular induction of cardiac arrhythmias) for hallucinations or clonidine for vegetative disorders.
  • Carbamazepine can also be given to prevent withdrawal cramps .
  • Caution is always advised when using tranquilizers with regard to breathing, as most of these substances have a respiratory depressive effect.
  • An alcohol predilection can also be quickly interrupted by giving alcohol intravenously. This is useful if a second illness has to be treated, the course of which is made worse by an additional delirium. However, the doses required cannot be reliably estimated beforehand. The interaction of (sedating) medication and alcohol is also potentially dangerous, especially because of respiratory depression, so that alcohol should be advised against as a rule. An already fully developed delirium tremens can usually no longer be broken through the administration of alcohol.
  • Additional treatment:
    • Monitoring of fluid, mineral and energy balance.
    • Protection against injuries
    • Protection against cooling down
    • Detection and treatment of comorbidities such as pneumonia, pancreatitis, liver cirrhosis

See also

literature

Web links

Wiktionary: Delirium tremens  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Schulspiegel June 15, 2006: Why Drunk People See White Mice