Delirium tremens

Medical emergency that requires inpatient care

• Agitation

• Confusion

• Paranoia

• Visual/auditory hallucinations

Management options

• Oral lorazepam

• Parenteral lorazepam

• Haloperidol

Question

A 56-year-old woman is seen on a home visit with a 12-hour history of fever, shivering and confusion. She has a history of alcohol dependence, typically consuming a bottle of gin per day. Her husband tells you that she has recently made several attempts to stop her alcohol intake completely as he has threatened to leave her if she continues to drink excessively.

On examination, she appears confused and shaky. She has a temperature of 38.1°C, a pulse rate of 120 beats/min and a respiratory rate of 24 breaths/min. She has no other respiratory symptoms and her chest is clear.

What is the SINGLE MOST likely cause of this patient’s symptoms?

1. Ascending cholangitis

2. Delirium tremens

3. Acute pancreatitis

4. Wernicke’s encephalopathy

5. Korsakoff’s psychosis

Delirium tremens is a medical emergency. It is an acute confusional state associated with tremor and autonomic dysfunction. The essential feature is that it develops within one week following the cessation of heavy ingestion of alcohol or a reduction in the amount of alcohol ingested