1/13. Refractory delirium tremens treated with propofol: a case series.delirium tremens, the most serious manifestation of alcohol withdrawal, occurs in approximately 5% of hospitalized alcoholics and has a mortality rate approaching 15%. patients with delirium tremens are usually treated in an intensive care unit in which benzodiazepines form the cornerstone of therapy. In this report, we describe four patients who proved refractory to high doses of benzodiazepines and were successfully treated with a propofol infusion.- - - - - - - - - - ranking = 1keywords = alcoholic (Clic here for more details about this article) |
2/13. Quantification of the alcohol withdrawal syndrome in 487 alcoholic patients.While the alcohol withdrawal syndrome (AWS) is frequently encountered in a number of medical settings, its clinical management is inconsistent. Appropriate management of the AWS can be enhanced by objectively quantifying principal symptoms. The modified or Milwaukee Selective Severity Assessment (MSSA) measures 10 symptoms of the AWS, providing clinicians with a quantitative indication of the syndrome's severity. The MSSA was administered to 487 successively admitted alcoholics entering an inpatient chemical dependency treatment center. The MSSA was used to evaluate the severity, monitor progression, and determine efficacy of treatment of the AWS. The MSSA aided clinicians in deciding which patients required pharmacologic intervention for their AWS. Two groups of patients are described: 435 whose AWS was not judged to be severe enough to require medication, and 52 whose AWS was sufficiently severe to warrant pharmacologic intervention. The MSSA allowed clinicians to accurately identify patients requiring pharmacologic intervention of the AWS: only 10.6% of 487 hospitalized alcoholics required pharmacotherapy. The MSSA is a convenient, effective, and efficient tool for monitoring the AWS.- - - - - - - - - - ranking = 6keywords = alcoholic (Clic here for more details about this article) |
3/13. Severe electrolyte abnormalities and paralytic ileus complicating delirium tremens.pneumonia and cardiac arrhythmias represent the most common life-threatening complications during delirium tremens. Electrolyte abnormalities are common underlying conditions in chronic alcoholics and they may further complicate the management of patients with alcohol-withdrawal syndrome or with delirium tremens. The authors present two cases in which the clinical picture of severe paralytic ileus complicating delirium tremens was closely associated with electrolyte status and postulate that the two were cause-effect related. A careful electrolyte supplement therapy guided by a strict monitoring of electrolyte balance and renal function proved to be particularly useful in successful management.- - - - - - - - - - ranking = 1keywords = alcoholic (Clic here for more details about this article) |
4/13. delirium tremens: a prospective long-term follow-up study.A follow-up by health insurance records of 716 male hospital-treated alcoholics revealed a tendency to a more favorable long-term adjustment in patients with delirium tremens at first admission compared with others. Standardized ratings at first admission indicated that the delirium patients had lower frequencies of depressive symptomatology, personality disturbance and social complications. Slight cerebral impairment at first admission was more frequent in the delirium patients, perhaps indicating a more severe abuse. In a subsample of 105 personally followed-up patients it was found that subjects with delirium later during the course of their illness were characterized by a lower level of social stability at first admission, compared with those with an initial delirium or with no history of delirium tremens. Contrary to initial delirium, later delirium was related to an unfavorable course. Six subjects with a history of delirium tremens were found to have taken up social drinking. Patterns and processes of improvement were found to be related more to background characteristics in terms of personality disturbance and social stability than to the severity of withdrawal symptoms.- - - - - - - - - - ranking = 1keywords = alcoholic (Clic here for more details about this article) |
5/13. alcohol withdrawal seizures.Seizures that occur in relation to alcohol withdrawal, following a period of prolonged intoxication in serious alcoholics, constitute a special syndrome with important prognostic and therapeutic implications. Inpatient management is desirable to eliminate other causes of seizures that occur for the first time in adult life and because such patients are at substantial risk for additional seizures and the development of delirium tremens. drug therapy with benodiazepines may be effective during the withdrawal period but long-term anticonvulsant treatment is of no value.- - - - - - - - - - ranking = 1keywords = alcoholic (Clic here for more details about this article) |
6/13. Spindle coma in benzodiazepine toxicity: case report.A forty-two year old female with known alcoholic liver disease was given intravenous lorazepam and diazepam for delirium tremens. This resulted in a comatose state with depression of some brainstem reflexes. Her initial EEG showed a pattern of spindle coma with some responsivity of the background. Clinical improvement occurred with cessation of the benzodiazepines and the EEG showed a return to normal patterns. A review of the literature showed no previous description of this pattern in benzodiazepine coma. Two reports of spindle coma are noted with alcohol and imipramine. The prognostic significance of this pattern in drug overdose is therefore not definitive by itself. Outcome is probably more dependent on the clinical condition of the patient and the reversibility of the drug toxicity.- - - - - - - - - - ranking = 1keywords = alcoholic (Clic here for more details about this article) |
7/13. Fat embolism syndrome in delirium tremens.delirium tremens in a common feature in the alcoholic population. The Fat embolism syndrome (FES) is characterized by fever, encephalopathy, respiratory failure and skin petechiae. Fat embolism has been associated with alcoholics but the diagnosis was apparent only at autopsy. We present an alcoholic male who developed delirium tremens unresponsive to therapy, followed by features of the FES. Asterixis and Korsakoff's psychosis are newly described features of this syndrome. Corticosteroids were a definitive therapy in this case.- - - - - - - - - - ranking = 3keywords = alcoholic (Clic here for more details about this article) |
8/13. Alcoholic epilepsy. A definition and a description of other convulsions related to alcoholism.The role of alcohol intake and withdrawal in so-called alcoholic epilepsy is discussed and illustrated by case reports. A classification is made which includes definitions of withdrawal convulsions, tetany-like withdrawal convulsions and alcohol-induced epileptic fits, with or without predisposing features.- - - - - - - - - - ranking = 1keywords = alcoholic (Clic here for more details about this article) |
9/13. Transient choreiform dyskinesias during alcohol withdrawal.Three chronic alcoholics developed choreiform dyskinesias involving the face, lips, tongue and, in one case, all limbs; 2 patients for the first time, 9 to 10 days after alcohol withdrawal. These abnormalities improved spontaneously with maintained abstinence from alcohol for 2 to 7 weeks. None had a family history of movement disorder, there was no history of other psychoactive drug use or abuse, and there was no evidence of portal-systemic encephalopathy.- - - - - - - - - - ranking = 1keywords = alcoholic (Clic here for more details about this article) |
10/13. Cardiac arrest following chlormethiazole infusion in chronic alcoholics.Two chronic alcoholics who had cardiac arrests (one fatal) while receiving chlormethiazole by infusion are reported. Although a causal relationship has not been indisputably established, caution is advised when administering this drug to chronic alcoholics during withdrawal.- - - - - - - - - - ranking = 6keywords = alcoholic (Clic here for more details about this article) |
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