Delirium tremens medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Delirium tremens}} | {{Delirium tremens}} | ||
{{CMG}} {{AE}} {{ZMalik}} | {{CMG}} {{AE}} {{ZMalik}} | ||
==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
*The mainstay of treatment for delirium tremens is supportive care and sedation. | |||
*For sedation, [[benzodiazepines]] are the first choice. To achieve a stable serum level of [[benzodiazepine]], it is preferred to use long-acting [[drugs]] such as [[diazepam]] and [[chlordiazepoxide]] as compared to short-acting [[benzodiazepine]]. | |||
*There are three options for the [[treatment]] of delirium tremens, | |||
**Front loading (Most preferred) | |||
**Symptom-triggered | |||
**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 [[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drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances.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drugs such as [[paraldehyde]] and [[clomethiazole]] were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances.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. | ||
Revision as of 15:51, 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
Medical Therapy
- The mainstay of treatment for delirium tremens is supportive care and sedation.
- For sedation, benzodiazepines are the first choice. To achieve a stable serum level of benzodiazepine, it is preferred to use long-acting drugs such as diazepam and chlordiazepoxide as compared to short-acting benzodiazepine.
- There are three options for the treatment of delirium tremens,
- Front loading (Most preferred)
- Symptom-triggered
- 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.