Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-25T01:42:35.526Z Has data issue: false hasContentIssue false
  • English
  • Français

Delayed-onset delirium tremens – a diagnostic and management challenge

Published online by Cambridge University Press:  24 June 2014

Sahoo Saddichha ,
Narayana Manjunatha ,
Baxi Neeraj Prasad Sinha  and
Christoday R.J. Khess
Sahoo Saddichha*
Affiliation:
National Tobacco Control Program, WHO India, Kolkata, India
Narayana Manjunatha
Affiliation:
Centre for Addiction Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, India
Baxi Neeraj Prasad Sinha
Affiliation:
Clifton House, Teesdale South, Thornaby Place, Stockton-on-Tees, UK
Christoday R.J. Khess
Affiliation:
Centre for Addiction Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, India
*
Sahoo Saddichha, National Tobacco Control Program, WHO India, Kolkata, India. Tel: +919836530262; Fax: +916742572660; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Delirium tremens (DT) is one of the most serious complications of alcohol withdrawal, affecting 5–10% of in-patients with a mortality rate up to 15%. DT, characterised by delirium and tremors, appears within 48–72 h of abstinence and persists for about 5–10 days.

Case presentation:

We report a case of DT in a young man with delayed onset on the 15th day after the cessation of alcohol use, despite an uncomplicated detoxification with benzodiazepine treatment.

Conclusion:

We hypothesise that the intake of country liquor in our patient, which contains higher percentages of alcohol, causes a prolonged imbalance of N-methyl-d-aspartic acid and glutamate receptor activity, leading to the picture of delayed-onset DT and that an atypical presentation at the time of admission and atypicality in early course are clinical pointers to the subsequent development of delayed-onset DT.

Keywords

delayed onsetdelirium tremens
Type
Case Report
Information
Acta Neuropsychiatrica , Volume 20 , Issue 3 , June 2008 , pp. 152 - 156
Copyright
Copyright © 2008 Blackwell Munksgaard

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Victor, M, Adams, RD. The effect of alcohol on the nervous system. Res Publ Assoc Res Nerv Ment Dis 1953;32:526–573. Google Scholar
Isbell, H, Fraser, HF, Wikler, Aet al. An experimental study of the etiology of rum fits and delirium tremens. Q J Stud Alcohol 1955;16:1–33. Google ScholarPubMed
Schuckit, MA, Barunwald, E. Alcohol and alcoholism. In: Braunwald, E, Fauci, AS, Kasper, DL, Hauser, SL, Longo, DL, Jameson, JL, eds. Harrison’s principle of internal medicine, 15th edn. New York: McGraw-Hill, 2001–2004: 387, 1036. Google Scholar
Guthrie, SK. The treatment of alcohol withdrawal. Pharmacotherapy 1989;9:131–143. CrossRefGoogle ScholarPubMed
Myrick, H, Anton, RF. Treatment of alcohol withdrawal. Alcohol Health Res World 1998;22:38–43. Google ScholarPubMed
Feuerlein, W, Reiser, E. Parameters affecting the course and results of delirium tremens treatment. Acta Psychiatr Scand 1986;329:120–123. CrossRefGoogle ScholarPubMed
Miller, FT. Protracted alcohol withdrawal delirium. J Subst Abuse Treat 1994;11:127–130. CrossRefGoogle ScholarPubMed
Taylor, D, Paton, C, Kerwin, R. Substance misuse. In: The Maudsley prescribing guidelines, 8th edn. New York: Taylor & Francis, 2005–2006: 236–237. Google Scholar
Beroz, E, Conran, P, Blanchard, RW. Parenteral magnesium in the prophylaxis and treatment of delirium tremens. Am J Psychiatry 1962;118:1042–1043. CrossRefGoogle ScholarPubMed
Brenner, RP. The electroencephalogram in altered states of consciousness. Neurol Clin 1985;3:615–631. Google ScholarPubMed
Hamdi, E, Al-Suhaili, A, Abou-Saleh, MT, Amin, Y, Prais, V. Cerebral blood flow in alcohol withdrawal: relation to severity of dependence and cognitive impairment. Acta Neuropsychiatr 2003;15:55–62. CrossRefGoogle ScholarPubMed
Yücel, M, Lubman, DI, Velakoulis, Det al. Structural brain correlates of alcohol and cannabis use in recreational users. Acta Neuropsychiatr 2006;18:226–229. CrossRefGoogle ScholarPubMed
Hersh, D, Kranzler, HR, Meyer, RE. Persistent delirium following cessation of heavy alcohol consumption: diagnostic and treatment implications. Am J Psychiatry 1997;54:846–851. Google Scholar
Harper, CG, Giles, M, Finlay-Jones, R. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry 1986;49:341–345. CrossRefGoogle ScholarPubMed
Harper, CG. The incidence of Wernicke’s encephalopathy in Australia – a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry 1983;46:593–598. CrossRefGoogle ScholarPubMed
Turner, S, Daniels, L, Greer, S. Wernicke’s encephalopathy in an 18-year-old woman. Br J Psychiatry 1989;154:261–262. CrossRefGoogle Scholar
Trevisan, LA, Boutros, N, Petrakis, IL, Krystal, JH. Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health Res World 1998;22:61–66. Google ScholarPubMed
Tsai, G, Gastfriend, DR, Coyle, JT. The glutamatergic basis of human alcoholism. Am J Psychiatry 1995;152:332–340. Google ScholarPubMed
Nutt, D, Adinoff, B, Linnoila, M. Benzodiazepines in the treatment of alcoholism. Recent Dev Alcohol 1989;7:283–313. CrossRefGoogle ScholarPubMed
Lal, R. Substance use disorder – manual for physicians. New Delhi: National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, 2005. Google Scholar
Meena, KP, Vohra, AK, Rajput, R. Prevalence and pattern of alcohol and substance abuse in urban areas of Rohtak city. Ind J Psychiatry 2002;44:348–352. Google ScholarPubMed
Singh, J, Singh, G, Mohan, V, Padda, AS. Comparative study of prevalence of regular alcohol users among the male individuals in an urban and rural area of Distt. Amritsar, Punjab. Indian J Commun Med 2000;25:73–78. Google Scholar
Kanzow, WT. The clinical stages of alcoholic delirium and their therapeutic significance. Acta Psychiatr Scand 1986;73:124–128. CrossRefGoogle Scholar
Kiefer, F, Andersohn, F, Jahn, H, Wolf, K, Raedler, TJ, Wiedemann, K. Involvement of plasma atrial natriuretic peptide in protracted alcohol withdrawal. Acta Psychiatr Scand 2002;105:65. CrossRefGoogle ScholarPubMed
Mann, KF. Alcohol and psychiatric and physical disorders. In: Gelder, MG, Lopez-Ibor, JJ, Andreasen, NC, eds. New Oxford Textbook of Psychiatry. Oxford: Oxford University Press, 2004: 491. Google Scholar
Abou-Saleh, MT. Psychopharmacology of substance misuse and comorbid psychiatric disorders. Acta Neuropsychiatr 2004;16:19–25. CrossRefGoogle ScholarPubMed
Kiefer, F, Andersohn, F, Otte, C, Wolf, K, Jahn, H, Wiedemann, K. Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence. Acta Neuropsychiatr 2004;16:233–238. CrossRefGoogle ScholarPubMed