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Delirium Tremens
History
- Excessive drinking for years
- 2-4 days after withdrawal from alcohol
- Trauma or infection in 50% of cases
- Biochemical evidence of liver damage in 90% of cases
Clinical Features
- Dramatic and rapid onset
- Clouding of consciousness
- Disorientation in time and place
- Inattention
- Agitation, restlessness
- Sleeplessness
- Illusions, vivid hallucinations
- Delusions
- Fearfulness
- Tremor
- Ataxia
- Autonomic disturbance
- sweating
- tachycardia
- raised blood pressure
- dilation of pupils
- Worse at night
- Convulsions and coma can lead to death
Investigations
- Leucocytosis
- Hyponatraemia
- Raised ESR
- (EEG - shows fast activity)
Management
as Medical Emergency
- Transfer to medical ward
- Exclude / find
- IV fluids
- Antibiotics
- Thiamine, multivitamins
- Diazepam / Chlormethiazole
- Anticonvulsants
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