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__NOTOC__
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{{Delirium tremens}}
{{Delirium tremens}}
{{CMG}} {{AE}} {{ZMalik}}
{{CMG}} {{AE}} {{ZMalik}}
==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The mainstay of delirium tremens [[treatment]] is supportive care and [[sedatives]]. [[Benzodiazepines]] are the initial choice for [[sedation]]. To establish a consistent [[serum]] level, long-acting [[benzodiazepines]] such as [[diazepam]] and [[chlordiazepoxide]] are favored over short-acting [[benzodiazepines]].


OR
==Medical Therapy==
 
*Supportive care and sedation are the mainstay of [[treatment]] for delirium tremens.
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
*For [[sedation]], [[benzodiazepines]] are the first choice.
 
*Long-acting [[benzodiazepines]] such as, [[diazepam]] and [[chlordiazepoxide]] are preferred over short-acting [[benzodiazepine]] to achieve a stable [[serum]] level.
OR
*There are three approved techniques for the use of [[benzodiazepines]] in these [[patients]] to achieve an optimum level of [[sedation]] or to lower the CIWA score to <8: The techniques are:
 
**Front loading (Most preferred)
The majority of cases of [disease name] are self-limited and require only supportive care.
***5 mg IV [[Diazepam]] administered twice with interval of 10 mins
 
***10 mg IV [[Diazepam]] administered twice with interval of 10 mins
OR
***20 mg IV [[Diazepam]] administered twice with interval of 10 mins
 
***5-20 mg IV per hour.  
[Disease name] is a medical emergency and requires prompt treatment.
**This regimen is followed until the goal of light sedation of CIWA score of <8 is achieved.
 
**Symptom-triggered
OR
***10–20 mg IV [[diazepam]] administered every 1–4 hours until the [[treatment]] goal is met.  
 
***If using [[lorazepam]], then 4 mg IV should be administered every 10 minutes.  
The mainstay of treatment for [disease name] is [therapy].
**Fixed-dose (Least preferred)
 
***Used only for [[alcohol withdrawal syndrome]] in an [[outpatient]] setting.
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR


Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].


OR
Contraindication: In case of [[liver]] impairment or lack of IV access, [[lorazepam]] is preferred over [[diazepam]].


Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].


OR


Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
==References==
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category: (name of the system)]]
==Medical Therapy==
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.
Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with [[benzodiazepine]]s, such as [[diazepam]] (Valium), [[lorazepam]] (Ativan) or [[oxazepam]] (Serax) and in extreme cases low-levels of [[antipsychotics]], such as [[haloperidol]] until symptoms subside. Older drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. [[Acamprosate]] is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If [[status epilepticus]] is present, [[seizure]]s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the [[visual hallucinations]] mentioned above.


Latest revision as of 23:54, 10 August 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

The mainstay of delirium tremens treatment is supportive care and sedatives. Benzodiazepines are the initial choice for sedation. To establish a consistent serum level, long-acting benzodiazepines such as diazepam and chlordiazepoxide are favored over short-acting benzodiazepines.

Medical Therapy

  • Supportive care and sedation are the mainstay of treatment for delirium tremens.
  • For sedation, benzodiazepines are the first choice.
  • Long-acting benzodiazepines such as, diazepam and chlordiazepoxide are preferred over short-acting benzodiazepine to achieve a stable serum level.
  • There are three approved techniques for the use of benzodiazepines in these patients to achieve an optimum level of sedation or to lower the CIWA score to <8: The techniques are:
    • Front loading (Most preferred)
      • 5 mg IV Diazepam administered twice with interval of 10 mins
      • 10 mg IV Diazepam administered twice with interval of 10 mins
      • 20 mg IV Diazepam administered twice with interval of 10 mins
      • 5-20 mg IV per hour.
    • This regimen is followed until the goal of light sedation of CIWA score of <8 is achieved.
    • Symptom-triggered
      • 10–20 mg IV diazepam administered every 1–4 hours until the treatment goal is met.
      • If using lorazepam, then 4 mg IV should be administered every 10 minutes.
    • Fixed-dose (Least preferred)


Contraindication: In case of liver impairment or lack of IV access, lorazepam is preferred over diazepam.



Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with benzodiazepines, such as diazepam (Valium), lorazepam (Ativan) or oxazepam (Serax) and in extreme cases low-levels of antipsychotics, such as haloperidol until symptoms subside. Older drugs such as paraldehyde and clomethiazole were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. Acamprosate is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If status epilepticus is present, seizures are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the visual hallucinations mentioned above.

References

Template:WH Template:WS

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