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    Delirium Tremens Tugas

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    Veronica Yosita Ananda
    Delirium tremens is a severe form of alcohol withdrawal that includes sudden mental and nervous system changes. It is diagnosed after ruling out other potential causes of delirium. Risk factors include long-term heavy drinking, older age, and more days since the last drink. Symptoms include confusion, agitation, hallucinations, tremors, and seizures. Treatment involves preventing complications, managing symptoms like anxiety and seizures with benzodiazepines and anticonvulsants, and addressing electrolyte abnormalities and thiamine deficiency. Complications of treatment can include oversedation, respiratory depression, and cardiac arrhythmias.

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    Delirium Tremens Tugas

    Uploaded by

    Veronica Yosita Ananda
    81 views14 pages
    Delirium tremens is a severe form of alcohol withdrawal that includes sudden mental and nervous system changes. It is diagnosed after ruling out other potential causes of delirium. Risk factors include long-term heavy drinking, older age, and more days since the last drink. Symptoms include confusion, agitation, hallucinations, tremors, and seizures. Treatment involves preventing complications, managing symptoms like anxiety and seizures with benzodiazepines and anticonvulsants, and addressing electrolyte abnormalities and thiamine deficiency. Complications of treatment can include oversedation, respiratory depression, and cardiac arrhythmias.

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    Delirium Tremens Tugas (1)

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    Delirium tremens is a severe form of alcohol withdrawal that includes sudden mental and nervous system changes. It is diagnosed after ruling out other potential causes of delirium. Risk factors include long-term heavy drinking, older age, and more days since the last drink. Symptoms include confusion, agitation, hallucinations, tremors, and seizures. Treatment involves preventing complications, managing symptoms like anxiety and seizures with benzodiazepines and anticonvulsants, and addressing electrolyte abnormalities and thiamine deficiency. Complications of treatment can include oversedation, respiratory depression, and cardiac arrhythmias.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    81 views14 pages

    Delirium Tremens Tugas

    Uploaded by

    Veronica Yosita Ananda
    Delirium tremens is a severe form of alcohol withdrawal that includes sudden mental and nervous system changes. It is diagnosed after ruling out other potential causes of delirium. Risk factors include long-term heavy drinking, older age, and more days since the last drink. Symptoms include confusion, agitation, hallucinations, tremors, and seizures. Treatment involves preventing complications, managing symptoms like anxiety and seizures with benzodiazepines and anticonvulsants, and addressing electrolyte abnormalities and thiamine deficiency. Complications of treatment can include oversedation, respiratory depression, and cardiac arrhythmias.

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    JOURNAL READING

    Delirium Tremens

    Preceptor:
    dr. Iwan Sys, SpKJ

    By:
    Dwi Prasetyana Rosadi (201510401011001)
    Fajaruddin Ma’ruf (201510401011051)

    PSYCHIATRY
    MEDICAL FACULTY
    UNIVERSITY OF MUHAMMADIYAH MALANG
    2017
    DEFINITION
    Delirium tremens is rare and is a diagnosis by exclusion, so
    before commencing treatment, screen for other factors
    contributing to delirium, in particular:
     subdural haematoma

     head injury

     Wernicke’s encephalopathy

     hepatic encephalopathy

     Hypoxia

     Sepsis

     metabolic disturbances

     intoxication with or withdrawal from other drugs.


    Delirium Tremens

     A severe form of alcohol withdrawal that includes


    sudden and severe mental and/or nervous system
    changes.
    Risk Factors
     Excessive alcohol abuse over a period of years
     Average >8 years

     Being >40 years old

     Past history of severe alcohol withdrawal symptoms

     Strong alcohol cravings

     Increased number of days since last drink (prior to


    hospitalization)
    (Burns, 2011)

    (Moses, 2012)

    Clinical Manifestations
    Symptoms most often occur within 48 to 72 hours after the last drink

     Can last 1 week to 1 month

     Mental status changes


     Confusion, disorientation
     Difficulty staying awake, stupor
     Agitation
     Hallucinations
     Seeing/feeling things that are not there (skin crawling)

     Body tremors (shaking)

     Seizures
     Grand mal seizures
     60% of patients; have between 1-6 seizures

     Other symptoms of withdrawal


    (NIH, 2011)
     Anxiety, depression, head ache, nausea, sweating, palpitations
    Diagnostics
     BUN and Creatinine
     Can be elevated, normal or low

     Liver Function Test


     All parameters can be elevated

     Toxicology screening
     May indicate other drugs in the system

     Electrolyte Panel
     Metabolic Acidosis

     CT of head
     Likely negative
    (Epocrates, 2011.)
    TREATMENT

     Preventive measures.

     Eliminating and correcting somatic complications.

     Adjusting environmental conditions

     Symptomatic and supportive treatment.


    Treatment

     Medical Care
     Prescribe medications for symptoms
     Benzodiazepines: Ativan, Diazepam
     Anticonvulsants: Tegretol
     Thiamine: Vitamin B1
     Magnesium sulfate
     5% dextrose in 0.45%-0.9% NaCl

    (Burns, 2011)
    (Kneisl & Trigoboff, 2013)
     Clomethiazole
     The GABA-ergic model of alcohol withdrawal and
    withdrawal delirium favors benzodiazepines in the
    treatment.
     For adequate alleviation of delirious symptoms, four
    to six 300 mg clomethiazole capsules.

     Benzodiazepines
     short-acting agents are preferred (e.g. lorazepam,
    midazolam and oxazepam).
     Benzodiazepines (especially clonazepam and diazepam)
    are also beneficial in epileptic seizure management as
    epileptic activity is a frequent complication seen in
    alcohol withdrawal and withdrawal delirium (up to 30%).
    They are also the drugs of choice in sedative and
    hypnotic withdrawal deliria. Common use in anxiolytic
    or other indications (60-90 mg of diazepam equivalent a
    day).
     Antipsychotics
     Tiapride, an atypical D2/D3 antipsychotic agent, can
    be used in uncomplicated alcohol withdrawal
    syndrome.
     the doses can 300 to 1800 mg/day - oral and
    parenteral.

     Anticonvulsant
     The anticonvulsants of non-benzodiazepine type
    carbamazepine and oxcarbazepine with likely GABA-
    ergic and NMDA-blocking activity represent other
    drugs of possible use.
     Used in doses of 800 mg a day in both fixed and
    tapered regimens.
     clinician-rated withdrawal phenomena using fixed or
    tapered (over 5-9 days) regimen with 800 mg daily as
    an initial dose.
    Complications of
    Treatment
     Oversedation

     Respiratory depression **

     Aspiration pneumonitis

     Cardiac arrhythmias **

    (NIH, 2011)
    References
     Burns, M. (2011). Medscape reference. Retrieved from
    http://emedicine.medscape.com/article/166032-overview

     Epocrates. (2012). Diagnostic Tests. Retrieved from


    https://online.epocrates.com/noFrame/showPage.do?method=dis
    eases&MonographId=549&ActiveSectionId=34

     Kneisl, C. R., & Trigoboff, E. (2013). Contemporary psychiatric-


    mental health nursing. (3rd ed.). Boston, MA: Pearson Education,
    Inc.

     Moses, S. (2012). Alcohol withdrawal. Retrieved from


    http://www.fpnotebook.com/Psych/CD/AlchlWthdrwl.htm

     NIH (2011). Delirium Tremens dts; alcohol withdrawal- delirium tremens.


    Retrieved from
    http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001771/

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