what is it?
Delirium tremens (delirium tremens, metalkogolny psychosis) - a severe mental condition requiring
emergency medical care.
Who can develop delirium alcohol?
It occurs only in people suffering from alcoholism 2-3 stage, when the duration of alcohol abuse more than 10-15 years. Much less delirium tremens can occur in people who do not suffer from chronic alcoholism, but after a long episode of alcohol in large amounts of alcohol or drug substitutes.
Alcoholic delirium develops against the backdrop of withdrawal syndrome, ie after stopping alcohol use (binge after).
The risk of developing delirium tremens greater in people who have had previous traumatic brain injury, severe central nervous system diseases, including inflammatory disorders, in patients who already had previous episode of delirium tremens.
Hospital delirium tremens. Symptoms and Syndromes
Delirium alcohol often develops 2-3 days after discontinuation of alcohol. The harbinger of the main symptoms of delirium tremens may be sleep disturbance. Sleep restless, accompanied by nightmares, does not lead to rest. Can appear symptoms such as headache, nausea, vomiting, impaired speech, etc. However, they are not specific and often accompany any withdrawal.
The clinic of delirium tremens can be divided into 3 groups of syndromes:
-organic brain damage.
Early symptoms of delirium tremens are anxiety, a feeling of inexplicable threat, fear. There are somatic symptoms: excessive sweating, hand tremors, heart palpitations, high blood pressure. Sleep disturbance is gradually transformed into insomnia. Sick pursue vivid auditory and visual hallucinations. Most often, they contain small insects: cockroaches, bugs or animals. There may be a tactile hallucination: sensation of insects crawling on the body, and are likely to try to round up or crush them.
During delirium tremens patient can "hear" the voice, something he was ordered, he swears, name-calling, teasing. Human behavior becomes inadequate. He completely captured by hallucinations, "talking" to someone shouts, trying to escape, "catches" on his clothes and "insects", etc. Sometimes it is seen boastful behavior: in a state of excitement patient talks about his "exploits".
Status field may be followed by periods of imaginary prosperity, during which the behavior becomes more calm and adequate. However, after a short period of time the symptoms of delirium tremens renewed.
Because somatic symptoms in the expanded clinic of delirium tremens are: hyperthermia (up to 38-39 ° C), high arterial hypertension (160-180 / 110 mm Hg. V.), Tremors, increased tendon reflexes, increased sweating. Violated the work of all internal organs.
A typical alcoholic delirium lasts 3-5 days. The first positive sign of leaving the state of delirium tremens is to improve sleep.
Stages of delirium tremens
1. Threatening delirium.
Characterized by common symptoms of alcohol withdrawal. The patient can have all the symptoms described above, however, the severity of a minor. In the expanded clinic may appear disorientation in time and
Space, however, is maintained awareness of their own body lichnosti.Temperatura not exceed subfebrile. This stage is reversible and can end at random.
2. Take a delirium.
All symptoms pronounced. Picking up auditory, visual and tactile hallucinations. There are delusional experiences, mostly unpleasant character. Deteriorating somatic condition: shortness of breath to 22-24 breaths per minute, increases blood pressure (blood pressure), pulse. At this stage of spontaneous resolution of delirium tremens is impossible. Without the timely assistance provided, this stage passes quickly enough 3.
3. life-threatening delirium.
Saves all mental symptoms, along with the obvious physical burdening. Appears lethargy, slurred speech, quiet (murmur), decreased response to external stimuli. Blood pressure drops sharply, filling pulse weakens, shortness of breath quickens. Gradually growing oppression of consciousness to coma. At this stage can occur irreversible changes of the internal organs and systems, comes decompensation and possibly death.
Complications of alcoholic delirium
- acute pancreatitis;
- pneumonia (frequency of the order of 30%);
- Alcoholic cardiomyopathy;
- hepatic impairment;
- brain edema;
- acute renal failure;
- disruption of water and electrolyte balance and acid-base balance;
- rhabdomyolysis etc.
Treatment of delirium tremens
Delirium tremens - a state, not only need to monitor the patient to ensure the safety of himself and others, but also requires a fairly intensive drug therapy. In some cases, even necessary resuscitation. Treatment of delirium tremens is preferably carried out on the basis of neuropsychiatric hospital with compulsory resuscitation doctor and therapist.
It offers a lot of drugs, but currently there is no single point of view on the algorithm of treatment of delirium tremens.
In Europe, the standard treatment for delirium tremens is the appointment clomethiazole. In Russia and the United States were the drugs of choice are benzodiazepines. These disadvantages include respiratory depression, sedation cumulation.
In most cases, treatment for delirium tremens is a combination therapy with intravenous benzodiazepines and haloperidol (or droperidol).
Along with knocking the psychic symptoms in the treatment of delirium tremens shown holding of intensive activities aimed at the elimination of somatic disorders. When you assign all drugs should be aware of the degree of their influence on the nervous system and the possibility of the appointment of this group of patients with chronic alcoholism.