Critical Care A Day
Thursday November 27, 2020
Thursday November 27, 2020
Q: Patients with delirium tremens (DT) usually develop? (select one)
A) respiratory alkalosis
B) respiratory acidosis
Answer: A
Patients with DT develops hyperventilation causing respiratory alkalosis. This is an important development as this leads to a clinically significant decrease in cerebral blood flow. The overall effect is correlated with the level of clouding of the sensorium in DT. This is another reason phenytoin is not very effective in seizures in DT.
Said that interestingly, there is no association between a decrease in cerebral blood flow and hallucinations or degree of tremors. It should be remembered that alcoholic hallucinosis and DT are two different phenomena. Alcoholic hallucinosis occurs early in the case of alcohol withdrawal and is not a cause or result of DT.
#toxicology
References:
1. Berglund M, Risberg J. Regional cerebral blood flow during alcohol withdrawal related to consumption and clinical symptomatology. Acta Neurol Scand Suppl 1977; 64:480.
2. Rathlev NK, D'Onofrio G, Fish SS, et al. The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures. Ann Emerg Med 1994; 23:513.
3. Wood E, Albarqouni L, Tkachuk S, et al. Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. JAMA 2018; 320:825.
A) respiratory alkalosis
B) respiratory acidosis
Answer: A
Patients with DT develops hyperventilation causing respiratory alkalosis. This is an important development as this leads to a clinically significant decrease in cerebral blood flow. The overall effect is correlated with the level of clouding of the sensorium in DT. This is another reason phenytoin is not very effective in seizures in DT.
Said that interestingly, there is no association between a decrease in cerebral blood flow and hallucinations or degree of tremors. It should be remembered that alcoholic hallucinosis and DT are two different phenomena. Alcoholic hallucinosis occurs early in the case of alcohol withdrawal and is not a cause or result of DT.
#toxicology
References:
1. Berglund M, Risberg J. Regional cerebral blood flow during alcohol withdrawal related to consumption and clinical symptomatology. Acta Neurol Scand Suppl 1977; 64:480.
2. Rathlev NK, D'Onofrio G, Fish SS, et al. The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures. Ann Emerg Med 1994; 23:513.
3. Wood E, Albarqouni L, Tkachuk S, et al. Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. JAMA 2018; 320:825.