A 48-year-old male presents to the ER with confusion and shaking of the entire body. He has a history of alcoholism. What is the cause of delirium tremens on an alcoholic?
Ans. (D) Acute infection(Ref: Kaplan and Sadock's Concise Text book of Clinical Psychiatry 11th Ed; Page No- 631)Acute infection is the cause of the delirium tremens in an alcoholic patient.Physical illness, e.g. hepatitis or pancreatitis predisposes to the syndromes; a person in good physical health rarely has delirium tremens during alcohol withdrawal.Gradual withdrawal from alcohol doesn't cause delirium tremens. However, sudden withdrawal can cause it.Delirium TremensDelirium tremens is the most serious form of alcohol withdrawal involving mental status and neurological changes.It starts 48-96 hours after last drink; but may occur later.Delirium tremens carries a 5% mortality rate but occurs in only 5% of patients that experience EtOH withdrawal.It occurs rarely in healthy people.Risk factors:#Pancreatitis#Hepatitis or other illness.Note: Physical illness predisposes to the conditionAge > 30 and prior DTs increase the risk.Symptoms:#Visual hallucinations (Most common)#Hypertension#Disorientation#Low-grade fever#Severe agitation#Tachycardia and#diaphoresisDiagnosis: The all alcohol-related withdrawal syndromes are made clinically, not by lab valuesTreatment:#It is a medical emergency and should be treated with adequate doses of benzodiazepines.#Prevention of DT is the best treatment.
Small consumption of alcohol
Gradual withdrawal from alcohol
Fatty liver
Acute infection
Substance Abuse