Delirium Tremens (DTs) Treatment & Management: Approach Considerations, Benzodiazepines, Adjunct Therapies (2024)

FAQs

Which benzodiazepine is best for delirium tremens? ›

Although diazepam is the preferred benzodiazepine, lorazepam is an excellent alternative and is especially useful in elderly persons and in those with severe hepatic dysfunction. It is commonly used prophylactically to prevent DTs.

Supportive therapy is an important component of the treatment of alcohol withdrawal syndrome and delirium tremens (DTs). Such therapy includes providing a calm, quiet, well-lit environment; reassurance; ongoing reassessment; attention to fluid and electrolyte deficits; and treatment of any coexisting addictions.

Benzodiazepines are preferred over neuroleptics for treatment of delirium resulting from alcohol or sedative hypnotic withdrawal. They also may be used when unknown substances may have been ingested and may be helpful in delirium from hallucinogen, cocaine, stimulant, or PCP toxicity.

Benzodiazepines are first-choice medications to treat alcohol withdrawal symptoms. They're the most effective and safe treatment for people with alcohol withdrawal syndrome (AWS).

In terms of selection of an antipsychotic medication, haloperidol is the most preferred agent. It is one of the oldest molecules used in the management of delirium. In fact, all the newer antipsychotics, which have been evaluated in the management of delirium, have been compared against haloperidol.

Delirium tremens was first recognized as a disorder attributed to excessive alcohol use in 1813. It is now commonly known to occur as early as 48 hours after abrupt cessation of alcohol in those with chronic use and can last up to 5 days. It has an anticipated mortality of up to 37% without appropriate treatment.

Your brain gets overstimulated. People with alcohol use disorder who suddenly stop drinking may also have a spike in an amino acid called glutamate. Glutamate causes some common delirium tremens symptoms, such as a sudden, extreme spike in blood pressure, tremors, severe excitability, and seizures.

If needed, arrange for a 24-hour caregiver or nurse, so your loved one is never left alone. Or take turns sitting next to the person's bedside with other family members and friends. Alert the healthcare provider if your loved one's delirium gets worse.

Mortality was as high as 35% prior to the era of intensive care and advanced pharmacotherapy. The most common conditions leading to death in patients with DTs are respiratory failure and cardiac arrhythmias.

Delirium risk appears to be increased with opioids (odds ratio [OR] 2.5, 95% CI 1.2–5.2), benzodiazepines (3.0, 1.3–6.8), dihydropyridines (2.4, 1.0–5.8) and possibly antihistamines (1.8, 0.7–4.5). There appears to be no increased risk with neuroleptics (0.9, 0.6–1.3) or digoxin (0.5, 0.3–0.9).

How long does delirium take to clear? ›

The deterioration of mental faculties might affect their understanding of their surroundings and situation, which can make it very frightening for them. Delirium often comes and goes and fluctuates throughout a day. Most cases of delirium resolve within days, but some do persist for weeks or months.

Short-acting benzodiazepines (BDZs). These agents, such as midazolam and lorazepam, can have a neurogenic effect. They are exclusively useful in patients with alcohol or sedative withdrawal or for delirium resulting from seizures.

In many European ICUs, including ours, the i.v. use of clonidine has become a common therapeutic ap- proach for delirium tremens. Infusion rates up to 180 mcg/h (30 amp/24 h) have reportedly been given with good clinical success while only few side effects, mostly hypotension, have been observed [1].

Lorazepam (off-label indication) should only be used for the treatment of challenging behaviour associated with delirium on the advice of a specialist.

Haloperidol, administered intravenously, is the preferred treatment for agitated delirious patients (as described by the guidelines of the American Psychiatric Association²²) despite the fact that this route of administration has not been approved by the US Food and Drug Administration and that it now carries a “black ...