Delirium tremens, or acute metal-alcohol psychosis, is observed in patients with alcohol dependence in stages II-III of the disease and is characterized by a combination of delirium syndrome and severe somato-vegetative, neurological disorders.
What causes delirium tremens?
The main causes of delirium tremens:
- heavy and prolonged binges;
- use of alcohol substitutes;
- severe somatic pathology;
- organic brain damage.
The pathogenesis of alcoholic delirium is not fully known; disturbances in the metabolism of CNS neurotransmitters and severe, primarily endogenous intoxication, are presumably of great influence.
Symptoms of delirium tremens
According to epidemiological studies, most often the first delirium tremens develops no earlier than 7-10 years of the existence of the advanced stage of alcoholism. Alcoholic delirium usually develops at the height of alcohol withdrawal syndrome (most often on the 2-4th day) and, as a rule, manifests itself in the evening or at night. Early signs of approaching delirium tremens are restlessness and restlessness of the patient, severe anxiety and persistent insomnia. Signs of excitation of the sympathoadrenal system are increasing - pallor of the skin, often with a bluish tint, tachycardia and arterial hypertension, hyperhidrosis, moderate hyperthermia. Always present to one degree or another are expressed autonomic disorders(ataxia, muscle hypotonia, hyperreflexia, tremor). Characteristic disturbances in the water-electrolyte balance are observed (dehydration, hyperazotemia, metabolic acidosis, etc.), changes in the blood picture (leukocytosis, shift leukocyte formula to the left, increased erythrocyte sedimentation rate, increased bilirubin content, etc.), low-grade fever.
Autonomic and neurological disorders occur before the onset of disorders of consciousness and persist for a long time after their reduction. Then the disorders described above are joined by pareidolic illusions (flat images of changeable, often fantastic content, usually their basis is a really existing drawing, ornament, etc.). The illusory perception of the environment is quickly replaced by the appearance of visual hallucinations. Psychotic disorders can be unstable: when the patient is activated, hallucinatory disorders can be temporarily reduced and even disappear completely.
Reduced forms of delirium tremens
Hypnagogic delirium is characterized by numerous vivid, scene-like dreams or visual hallucinations when falling asleep or closing the eyes. An increase in psychotic symptoms is noted both in the evening and at night, characterized by mild fear, an affect of surprise, and somato-vegetative symptoms typical of a delirious disorder. The content of hallucinations is varied: there may be frightening pictures (for example, a dangerous chase) and adventurous adventures. In some cases, the patient is transported to a hallucinatory environment, which indicates partial disorientation. When opening your eyes or waking up, a critical attitude towards what you see is not immediately restored and this can affect the behavior and statements of the patient. Hypnagogic delirium tremens lasts, as a rule, 1-2 nights, and can be replaced by metal-alcohol psychoses of different structure and form.
Hypnagogic delirium tremens of fantastic content (hypnagogic onirism) differs from the variant described above in the fantastic content of abundant, sensually vivid visual hallucinations, the scene-like nature of hallucinatory disorders with a sequential change of situations. It is noteworthy: when the eyes are opened, the dreams are interrupted, and when they are closed, they are resumed again and, thus, the development of the hallucinatory episode is not interrupted. With this form of delirium, it is often not the affect of fear that predominates, but interest and surprise. One more distinctive feature- disorientation in the environment (as a constant symptom). The duration and outcomes are similar to the hypnagogic delirium variant.
Hypnagogic delirium tremens and hypnagogic onirism are not identified in ICD-10 as separate nosological forms.
Delirium without delirium, delirium tremens without delirium tremens (delirium lucidum, trembling syndrome) - I. Salum. (1972) (F10.44*) - an atypical form, characterized by the absence of hallucinations and delusions in the clinical picture. Occurs acutely. Major disorders contain neurological symptoms, expressed to a significant extent: distinct, rough tremor, ataxia, sweating. Disorders of orientation in time and space are transient. The affect of anxiety and fear is constant. The behavior is dominated by confusion, fussiness, restlessness, and excitement. The course of this form of delirium is short-term - 1-3 days, recovery is often critical. Transition to other forms of delirium is possible.
With abortive delirium tremens (F0.46*), prodromal phenomena are usually absent. In the clinical picture, isolated visual illusions and microscopic hallucinations are observed; Among other hallucinatory disorders, acoasmas and phonemes are most often observed. The affect of anxiety and fear is similar to other forms of delirious stupefaction. Delusional disorders are rudimentary, behavioral disorders are unstable and transient. Neurological disorders are not pronounced.
With the abortive course of delirium and relatively shallow clouding of consciousness, patients may have critical doubts about the reality of what is happening, even during hallucinatory experiences. The patient’s degree of criticality towards the experiences he has suffered increases with recovery and the associated disappearance of delirious symptoms. The duration of abortive delirium is up to 1 day. The output is critical.
Typical or classic delirium tremens
In typical delirium tremens, the symptoms flicker from several hours to a day, after which the hallucinations become permanent. Alcoholic delirium undergoes several successive stages in its development.
Prodromal period
During this period, which usually lasts several days, sleep disorders predominate (nightmarish, frightening dreams, fears), changeable affect with predominance is characteristic, and asthenic complaints are constant. In 20% of cases, the development of delirium tremens is preceded by severe and, less commonly, abortive epileptic seizures, most often occurring on the first or second day of alcohol withdrawal syndrome. On the 3-4th day from the onset of alcohol withdrawal syndrome, epileptic seizures are rare. In other cases, delirium may develop after an episode of verbal hallucinations or an outbreak of acute sensory delirium. When diagnosing alcoholic delirium, one should not forget about the possible absence of a prodromal period. I
First stage
Changes in mood that were present in the prodrome of the disease become more noticeable, and a rapid change of opposite affects is observed: depression, anxiety or fearfulness are easily replaced by euphoria, causeless fun. Patients are excessively talkative, restless, restless (akatasia). Speech is rapid, inconsistent, slightly incoherent, and attention is easily distracted. Facial expressions and movements are lively, fast, sharply changing. Disorientation or incomplete orientation in place and time is often observed. Orientation in one’s own personality, as a rule, is preserved even in the advanced stages of delirium tremens. Patients are characterized by mental hyperesthesia - a sharp increase in susceptibility when exposed to various stimuli, sometimes even indifferent ones. There are influxes of vivid memories, figurative ideas, visual illusions; sometimes there are episodes auditory hallucinations in the form of acoasms and phonemes, various elements of figurative delirium are noted, in the evening all symptoms increase sharply. Night sleep is disturbed, frequent awakenings in a state of anxiety are observed.
Emotional and psychomotor agitation, rapid change of affect are significant diagnostic signs to distinguish delirium tremens from alcohol withdrawal syndrome with a predominance of the mental component. In differential diagnosis, it is necessary to distinguish between the initial stage of development of delirium tremens and a hangover state, characterized by a typical monotonous depressed-anxious affect.
Second stage
The clinical picture of stage 1 is accompanied by pareidolia - visual illusions of fantastic content. They can be black and white or color, static or dynamic. Hypnagogic hallucinations of varying intensity are characteristic. Sleep continues to be intermittent, with frightening dreams. During awakenings, the patient cannot immediately distinguish a dream from reality. Hyperesthesia increases, photophobia increases. Light intervals are possible, but they are short-lived. Dream-like experiences alternate with a state of relative wakefulness, with stupor.
Third stage
At stage III, complete insomnia is observed, and true visual hallucinations occur. Characteristic are visual zoological hallucinations (insects, small rodents, etc.), tactile hallucinations (most often in the form of a very realistic sensation of the presence of a foreign object - a thread or a hair in the mouth), verbal hallucinations are possible, mainly of a threatening nature. Orientation in place and time is lost, but remains in one’s own personality. Hallucinations in the form of large animals or fantastic monsters occur much less frequently. Affective disorders are labile, fear, anxiety, and confusion predominate.
At the height of delirious disorders, the patient is an interested spectator. Hallucinations are scene-like or reflect certain situations. may be single or multiple, often colorless. As delirium tremens worsens, auditory, olfactory, thermal, tactile, and hallucinations also occur. general feeling. According to different data, hallucinatory phenomena are not just diverse, but complexly combined, combined. Visual hallucinations in the form of cobwebs, threads, wires, etc. are often encountered. Disorders of the body diagram come down to sensations of changes in the position of the body in space: surrounding objects begin to swing, fall, and rotate. The sense of time changes; for the patient it can be shortened or lengthened. Behavior, affect, delusional statements correspond to the content of hallucinations. Patients are fussy and have difficulty staying in place. Due to the prevailing affect of fear, patients try to run away somewhere, leave, hide, shake something off themselves, knock it down or rob it, turn to imaginary interlocutors. Speech in this case is abrupt, consisting of short phrases or individual words. Attention becomes hyper-distracted, mood is extremely changeable, facial expressions are expressive. For a short time, bewilderment, complacency, surprise, despair alternate one another, but fear is most often and most constantly present. In delirium, delirium is fragmentary and reflects hallucinatory disorders; the content here is dominated by delusions of persecution, physical destruction, and, less often, jealousy and adultery. Delusional disorders in delirium are not generalized; they are affectively intense, specific, unstable, and completely dependent on hallucinatory experiences.
Patients are highly suggestible. For example, if a patient is given a sheet of clean white paper and asked to read what is written, he sees text on this sheet and tries to reproduce it (Reichardt's symptom); the patient starts a long conversation with the interlocutor if you give him a switched-off telephone receiver or some other object called a telephone receiver (Aschaffenburg symptom). When pressing on the closed eyes and asking certain specific questions, the patient experiences corresponding visual hallucinations (Lillmann's symptom). It should be borne in mind that signs of increased suggestibility arise not only at the height of psychosis, but also at the very beginning of its development, and at its end, when acute symptoms are reduced. For example, you can cause persistent visual hallucinations in a patient after the end of delirium, if you force him to peer at shiny objects (Bechterew's symptom).
Another interesting point: the symptoms of psychosis can be weakened by the influence of external factors- distractions (conversations with the doctor, medical personnel). A typical symptom of awakening.
In stage III of typical delirium tremens, light (lucid) intervals can be observed, while patients experience significant asthenic symptoms. In the evening and at night, there is a sharp increase in the severity of hallucinatory and delusional disorders, and psychomotor agitation increases. anxiety can reach raptus levels. By morning, the described state turns into soporous sleep.
This is where the development of delirium tremens ends in most cases. The recovery from psychosis is usually critical - after deep, long sleep, but sometimes it is lytic - gradual; symptoms can be reduced in waves, with alternating weakening and resumption of psychopathological symptoms, but at a less intense level.
The patient's memories of the mental disorder experienced are fragmentary. He can remember (often in great detail) the content of painful experiences. hallucinations, but does not remember and cannot reproduce what was happening around him in reality, his behavior. All this is subject to partial or complete amnesia.
The end of delirium tremens is accompanied by intensely expressed emotional-hyperesthetic weakness. The mood is changeable: alternation of tearfulness, depression, elements of faint-heartedness with causeless sentimental contentment and enthusiasm are observed; asthenic reactions are required.
After reduction of the clinical picture of delirium, transitional syndromes are observed in some cases. These include residual delusions, an uncritical attitude towards the experience or individual delusional ideas, mild hypomanic (more often in men), as well as depressive, subdepressive or asthenic-depressive states (more often in women).
The structural-dynamic characteristics of the thought process partially change, but no pronounced incoherence or disintegration of thinking is observed. After exiting the psychotic state, a slowdown, a small product of notes, is noted. thinking, but it is always quite consistent and coherent. Possible manifestations of a kind of alcoholic reasoning, alcoholic humor
The course of delirium tremens is usually continuous (in 90% of cases), but can be intermittent: 2-3 attacks are observed, separated by light intervals lasting up to a day.
The duration of alcoholic delirium averages from 2 to 8 days; in a small percentage of cases (up to 5), delirium can last up to days.
Mixed forms of delirium tremens
Alcoholic delirium can become structurally more complicated: it is possible to add delusional experiences, the emergence of ideas of self-blame, damage, attitudes, and persecution. Hallucinations can become more complex, scene-like (everyday, professional, less often religious, battle or fantastic). In such cases, it is permissible to talk about mixed forms delirium tremens, among them systematized delirium and delirium with pronounced verbal hallucinations. These forms are not highlighted in ICD-10.
Systematized delirium tremens
The development of stages I and II does not differ from the course of typical delirium tremens. At stage III, multiple scene-like visual hallucinations begin to dominate the clinical picture. The content is dominated by scenes of persecution, while the patient is always the object of assassination attempt and pursuit. The patient’s behavior is dictated by the experiences he experiences: he tries to run away, hide, find a safe place to hide from his pursuers. The affect of fear is pronounced, constant, persistent. Less common are visual hallucinations with a predominance of public spectacles or erotic scenes, witnessed by the patient. Some authors emphasize the constancy of drinking plots. In such cases, the affect of surprise and curiosity predominates. Visual hallucinations coexist with a variety of illusions, pareidolia, false recognitions, false, constantly changing orientation in the environment. In this case, we talk about the development of visual hallucinosis in the structure of alcoholic delirium.
Delusional statements are interconnected with the content of hallucinations, are of a stating nature and change depending on changes in hallucinations. The harm, thanks to the sequence of the story and the “crazy details,” resembles a systematized one.
The clouding of consciousness does not reach a deep level, since the patient, upon emerging from a painful state, is able to reproduce the content of painful experiences. Autonomic and neurological disorders are shallow. The duration of psychosis is several days to a week or more. If the course of psychosis has acquired a princely character, then the way out is always logical, with residual delirium.
Delirium tremens with severe verbal hallucinations
In this case, we talk about the development of verbal hallucinosis in the structure of delirium. Along with the characteristic intense visual, thermal, tactile hallucinations, body diagram disorders, and visual illusions, there are constant verbal hallucinations. The contents of hallucinations are similar to other types of delirium tremens, usually of a frightening nature. That is why affect is determined primarily by anxiety, tension, and fear. Delusional statements resemble those in systematized delirium. However, in this case it should be noted: delusional statements are not supported by argumentation, so there is no need to talk about systematized delirium. In addition, signs of figurative delusion are identified - confusion, ideas of delusional staging, a symptom of a positive double, spreading to many people. Orientation in place and time is slightly impaired: the depth of confusion, despite the abundance of productive disorders, is insignificant. Neurological and autonomic disorders are also not pronounced. The duration of psychosis ranges from several days to several weeks. In the latter case, painful disorders disappear gradually, with residual delirium.
Severe delirium tremens
The identification of the group of severe delirium tremens is associated with pronounced somatovegetative and neurological disorders, features of psychopathological disorders, as well as the possibility fatal outcome. Severe delirium usually occurs in stage II-III or III alcoholism with high tolerance and constant use of alcohol. The development of severe delirium is often preceded by seizures. There are two forms of severe delirium - professional and excruciating.
Occupational delirium tremens (delirium with occupational delirium) F10.43*
Psychosis can begin with typical disorders; subsequently, a transformation of the clinical picture is observed, as a rule, its worsening. In this case, the intensity of hallucinatory phenomena decreases, the delusion of persecution weakens or disappears. Affective disorders become monotonous. Movement disorders and the patient's behavior also changes. Instead of well-coordinated actions that vary in content, requiring dexterity, strength, and significant space, monotonous movements of a limited scale and stereotypical nature begin to predominate. Patients perform their usual activities, including professional ones: dressing and undressing, counting money, signing papers, washing dishes, ironing, etc. Distractibility by external stimuli in this state gradually decreases, and in the future may disappear completely. In the initial period of delirium with professional delirium, changeable false recognition of surrounding persons and constantly changing false orientation in the environment are observed. Self-awareness is always preserved. As the condition worsens, false recognitions disappear, movements become more and more automated. Symptoms of stunning appear already during the day, this also indicates a deterioration in the condition.
Professional delirium tremens is usually accompanied by complete amnesia. Less commonly, individual memories related to the onset of psychosis are retained in memory. As the condition worsens, occupational delirium may turn into delirium, and transitional states may also occur in the form of transient dysmnestic, Korsakov's syndrome or pseudoparalysis.
Delirium tremens (delirium with muttering) F10.42*
Usually occurs after occupational delirium, less often - after other forms of delirium tremens with their autochthonous unfavorable course or the addition of intercurrent diseases. Delirium tremens can develop very quickly, within a few hours or days, with virtually no hallucinatory-delusional experiences. This condition is characterized by a combination of deep confusion, specific motor disorders and severe somatoneurological disorders. Motor excitation is also observed within the local population; it is limited to the rudimentary movements of grasping, pulling, smoothing, and robbing (carphology). Myoclonic jerks are often noted different groups muscles, choreiform hyperkinesis. Speech stimulation - a set of simple, short words, syllables, interjections; the voice is quiet, devoid of modulation. Symptoms of stunning increase as the condition worsens; they occur at night and daytime. Recovery is possible, after which the entire period of psychosis is amnesic.
It should be noted that with persistent delirium tremens, the leading place in the clinical picture may be occupied by neurological and autonomic disorders. With it, tachycardia, sudden changes in blood pressure are noted, more often its decrease until the development of collaptoid states, muffled heart sounds, hyperhidrosis, the development of oliguria up to anuria (unfavorable clinical symptom); subcutaneous hematomas often occur (capillary fragility, blood clotting disorders); hyperthermia (up to 40-41 °C), tachypnea, shallow, intermittent breathing are observed. Neurological symptoms presented by ataxia, tremor, hyperkinesis, symptoms of oral automatism, muscle tone disorders, neck muscle rigidity; possible urinary and fecal incontinence (unfavorable clinical sign).
As the clinical picture becomes more severe, amentia-like disorders, speech and motor incoherence appear.
Atypical delirium tremens
TO atypical forms delirium tremens is considered psychotic states with the presence and clinical picture of disorders characteristic of the endogenous process (schizophrenia). In these cases, symptoms characteristic of delirium tremens coexist with symptoms of mental automatism or are accompanied by oneiric clouding of consciousness. Atypical delirium tremens often occurs after repeated psychoses. Similar clinical forms are not identified in ICD-10 in the form of delineated syndromes, in this case it is justified to classify such conditions as withdrawal syndrome with delirium other (F10.48*).
Delirium tremens with fantastic content (fantastic delirium, alcoholic oneiroid, oneiroid delirium)
The prodromal period is dominated by multiple photopsia, acoasmas, elementary visual hallucinations, and episodes of figurative delusions. The development of alcoholic oneiroid occurs according to the type of complication of the clinical picture. Psychosis may begin as fantastic hypnagogic or classic delirium. During the daytime, visual and verbal hallucinations, figurative delusions, and delusional disorientation may occur. Lucid intervals are characteristic. On the 2-3rd day, usually at night, the clinical picture becomes more complicated: scene-like visual and verbal hallucinations appear, delusional disorders fantastic content, multiple false recognitions, motor excitement from complex coordinated actions turns to disordered, chaotic.
The content of the hallucinations experienced is more often of a fantastic nature; frightening visions are noted - wars, disasters, travel to exotic countries. In the minds of patients, events of everyday and adventure-fantastic content are intricately intertwined, without any particular sequence. Hallucinatory pictures are usually fragmentary and unfinished. Another interesting observation: with open eyes the patient is a spectator, with closed eyes he is a participant in the events taking place. At the same time, patients always have a feeling of rapid movement in space.
When scene-like visual hallucinations prevail in the clinical picture, general drowsiness and immobility increase; the condition resembles substupor or stupor. Tom, however, being in a state of inhibition, the patient answers questions, but only after repeated repetitions, in monosyllables. As with other types of delirium, autopsychic orientation is preserved, orientation in place and time is false. Double orientation is often observed - the coexistence of correct and false ideas. The patient's facial expressions resemble those of oneiroid - the frozen facial expression turns into a frightened, preoccupied, surprised one. In the initial stages of psychosis, the affect of fear predominates. With further complication of the clinical picture, fear disappears, replaced by curiosity, surprise, close to complacency. From time to time the patient tries to go somewhere, but with persuasion or slight coercion he calms down. There is no negativism.
The duration of psychosis is from several days to a week, the recovery is critical, after a deep, long sleep. Painful memories persist for quite a long time, the patient talks about them in detail even later long term. After psychosis, in some cases, residual delusions remain.
Delirium tremens with oneiric disorders (alcoholic onirism)
Delirium tremens with oneiric disorders is characterized by a shallow depth of stupefaction and a significantly lower severity of the illusory-delusional component compared to oneiric delirium. From the very beginning, the hallucinations are vivid. According to various authors, with onirism there are no pseudohallucinations of ordinary content, and mental automatisms are not expressed. Psychosis ends critically, after deep sleep, on the 6-7th day from its beginning.
Delirium tremens with mental automatisms
Mental automatisms arise when typical or highly systematized delirium becomes more complex, when delirium is combined with pronounced verbal hallucinations or in oneiric states. Mental automatisms are transient, incomplete, and almost all of their variants are observed - ideational, sensory, motor. Automatisms most often occur in isolated form, sometimes there are combinations of them (ideational with sensory or motor with sensory); however, according to many authors, three types of automatisms are never encountered simultaneously. When delirium is reduced, automatisms disappear first. The duration of psychosis varies up to 1.5-2 weeks. The outcome is critical; with the lytic variant, the formation of residual delirium is possible.
Differential diagnosis of delirium tremens
It is necessary to carry out differential diagnosis alcoholic delirium and delirious disorders resulting from acute intoxication drugs with an anticholinergic effect (atropine, diphenhydramine, etc.), stimulants (cocaine, zphedrine, etc.), volatile organic substances, for infectious diseases, surgical pathology(acute pancreatitis, peritonitis), feverish of different origins.
Differential diagnosis of alcoholic and intoxicating delirium tremens
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Delirium tremens in alcohol addiction |
Delirium tremens due to intoxication |
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Long-term systematic alcohol abuse, signs of alcohol dependence |
Epidemiological history |
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Clinical data |
No signs:
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Signs of substance intoxication |
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Laboratory data |
Signs of alcoholic liver damage (increased levels of liver enzymes), chronic intoxication(increased ESR, relative leukocytosis) |
Definition psychoactive substances in biological media Identification of an infectious agent Signs of surgical pathology (for example, high amylase levels in acute pancreatitis) |
If problems arise with diagnosing a delirious state, the help of an infectious disease specialist or surgeon may be necessary.
Treatment of delirium tremens and alcoholic encephalopathies (F10.40*)
Modern treatment tactics for delirium tremens, regardless of its severity, are aimed at reducing intoxication of the body, maintaining vital functions or preventing their impairment. Already with the development of early signs of delirium, plasmapheresis is prescribed with the removal of 20-30% of the volume of circulating plasma. Then carry out infusion therapy. Such tactics can significantly alleviate the course of psychosis, and in some cases, prevent its further development. The method of choice for detoxification therapy for typical delirium tremens is forced diuresis: massive infusions of solutions in a volume of 40-50 mg/kg under the control of central venous pressure, electrolyte balance, acid-base state of the blood, plasma glucose and diuresis; If necessary, diuretics and insulin are prescribed. Enterosorbents are also used as part of detoxification therapy.
It is necessary to replenish electrolyte losses and correct the acid-base state. Loss of potassium is especially dangerous, as it can cause tachyarrhythmias and cardiac arrest. For potassium deficiency and metabolic alkalosis, a 1% solution of potassium chloride is prescribed intravenously slowly, not more than 150 ml/day. If renal function is impaired, potassium preparations are contraindicated in each clinical situation, doses are set depending on the indications of water-electrolyte balance and acid-base status. To eliminate metabolic acidosis, buffer solutions containing so-called metabolizable anions of organic acids (acetate, citrate, malate, gluconate), for example, sterofundin, acesol and other solutions are used intravenously slowly under the control of acid-base balance.
Large doses of vitamins are added to solutions for intravenous infusion (thiamine - up to 1 g / day, pyridoxine, ascorbic and nicotinic acids).
Drugs that enhance metabolism are prescribed (1.5% solution of meglumine sodium succinate 400-800 ml intravenous drip 4-4.5 ml/min for 2-3 days or cytoflavin 20 40 ml in 200-400 ml 5% glucose solution intravenous drip 4- 4.5 ml/min for 2-3 days).
Cytoflavin is the first complex neurometabolic drug developed on the basis of modern knowledge and discoveries in the field of molecular biology of cellular respiration and clinical medicine.
Cytoflavin is a harmonious neuroprotective composition that promotes safe and rapid recovery from withdrawal symptoms.
After the first day of treatment, headache, sweating, weakness, and irritability disappear. After a course of therapy, sleep normalizes and decreases affective disorders. Cytoflavin is well tolerated and safe.
- Composition: in 1 ml of the drug: succinic acid- 100 mg, nicotinamide - 10 mg, riboxin - 20 mg, riboflavin - 2 mg.
- Indications: toxic (including alcoholic) encephalopathy, alcoholic withdrawal syndrome.
- Contraindications: individual intolerance to the components of the drug.
- Method of administration and dosage: 10 ml of solution intravenously diluted with 200 ml of glucose 2 times a day for 5 days.
- Packaging: ampoules with injection solution No. 10, No. 5.
Also necessary are agents that improve the rheological properties of blood (dextran (reopolyglucin) 200-400 ml/day], cerebral circulation(instenon solution 2 ml 1-2 times a day or 2% pentoxifylline solution 5 ml in a 5% glucose solution 1-2 times a day). Nootronic drugs that do not excite the central nervous system are used [Semax - 0.1% solution, 2-4 drops and nose 2 times a day or hopantenic acid (pantogam) 0.5 g 3 times a day), and hepatoprotectors | ademetionine (heptral) 400 mg 1-2 times a day, thioctic acid (espa-lipone) 600 mg 1 time a day|. Medicines and measures aimed at preventing hypoxia and cerebral edema are also indicated: 10% solution of meldonium (mildronate) 10 ml once a day or 5% solution of Mexidol 2 ml 2 3 times a day. 25% solution of magnesium sulfate 10 ml 2 times a day, oxygen therapy, hyperbaric oxygen therapy, cranial hypothermia, etc. Careful monitoring of the patient’s vital functions (respiration, cardiac activity, diuresis) and timely symptomatic therapy aimed at maintaining them are necessary (for example, the prescription of cardiac glycosides for heart failure, analeptics for respiratory dysfunction, etc. .). Specific selection of drugs and solutions for infusion, medicinal and non-drug therapy must be built taking into account the existing violations in each specific case.
Treatment of delirium tremens and acute encephalopathies
| Predelirium, prodromal period of acute alcoholic encephalopathy |
Treatment aimed at reducing intoxication, correcting electrolyte disturbances and improvement of the rheological properties of blood: |
| Treatment aimed at relieving psychomotor agitation and sleep disorders: 0.5% diazepam solution 2-4 ml intramuscularly or intravenously drip up to 0.08 g/day; 0.1% solution of phenazepam 1-4 ml intramuscularly and intravenously drip up to 0.01 g/day |
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| Vitamin therapy: 5% solution of thiamine (vitamin B1) 4 ml intramuscularly; 5% solution of pyridoxine (vitamin B6) 4 ml intramuscularly; 1% solution of nicotinic acid (vitamin PP) 2 ml intramuscularly; 5% solution ascorbic acid(vitamin C) 5 ml intravenously; 0.01% solution of cyanocobalamin (vitamin B12) 2 ml intramuscularly. |
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| Neurometabolic therapy: Semax - 0.1% solution 2-4 drops in the nose 2 times a day or hopantenic acid 0.5 g 3 times a day |
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Hepatoprotectors: |
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| Full-blown delirium tremens, acute alcoholic encephalopathy |
Fixation of the patient |
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Infusion therapy in a volume of 40-50 ml/kg under the control of central venous pressure, electrolyte balance, acid-base balance of blood, plasma glucose and diuresis, if necessary, diuretics and insulin are prescribed. Use 1.5% solution of meglumine sodium succinate (Reamberin) 400 -500 ml intravenous drip at a rate of 4-4.5 ml/min for 2-3 days or Cytoflavin 20-40 ml in 200-400 ml of 5% glucose solution intravenous drip at a rate of 4-4.5 ml/min 2-3 day, dextran (reopolyglucin) 200-400 ml/day, sterofundin, acesol/disol |
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Prevention of hypoxia and cerebral edema; |
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| For intractable agitation and convulsive conditions - short-acting barbiturates (sodium thiopental, texobarbital (hexenal) up to 1 g/day intravenous drip under constant monitoring of respiration and circulation) | |
| Oxygen therapy or hyperberic oxygen therapy | |
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Symptomatic treatment of somatic complications |
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Severe forms of delirium tremens, Gaye-Wernicke encephalopathy. |
Monitoring of vital functions (respiration, palpitations, diuresis), regular control, oxygen-alkaline balance, determination of concentrations of potassium, sodium, glucose in blood plasma |
| Balanced infusion therapy | |
| Cranial hypothermia | |
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Nootropic drugs: piracetam 5-20 ml of 20% solution intravenously, Cortexin 10 mg intramuscularly in 1 ml of 0.9% sodium chloride solution |
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Vitamin therapy |
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| Hyperbaric oxygenation course | |
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Symptomatic treatment of somatic complications |
It should be noted that in delirium tremens, the antipsychotic activity of existing psychotropic drugs has not been proven. They are prescribed when psychomotor agitation, expressed by anxiety and insomnia, as well as in the presence and history of convulsive seizures. Drugs of choice: benzodiazepine drugs 0.5% solution of diazepam (Relanium) 2-4 ml intramuscularly or intravenously drip up to 0.06 g/day; 0.1% solution of phenazepam 1-4 ml intramuscularly or intravenously drip up to 0.01 g/day and barbiturates short acting sodium thiopental, hexobarbital (hexenal) up to 1 g/day intravenous drip under constant monitoring of breathing and circulation. In case of severe delirium tremens (occupational, excruciating) and acute alcoholic encephalopathies, the administration of psychotropic drugs is contraindicated.
Delirium tremens - dangerous condition, which can develop in any binge alcoholic. If it was not possible to avoid its manifestations, then measures must be taken to stop this negative condition. Is it possible to treat delirium tremens at home and, if so, what should be done?
Manifestations
If delirium tremens symptoms have developed, treatment at home can be started only after relatives have confirmed the nature of the disease. The classic clinical picture can help with this, that is, the appearance of auditory and visual hallucinations in the patient. You can suspect the presence of hallucinations based on the following signs:
- As a rule, visual hallucinations frighten the patient, since he sees something that he fears in a sober state (this could be insects, spiders, rats, etc.) or he is haunted by imaginary images (monsters, devils, dead people) who want to cause harm. he is in pain;
- manifestations of auditory hallucinations may include complaints of incomprehensible screams, rustling noises, threats addressed to oneself or relatives, which the patient allegedly hears;
- the presence of deviations also manifests itself in facial expressions if the patient refuses to complain (you can notice fear on the face, a grimace of horror, sometimes a person shakes off something that he alone sees);
- Among the signs of delirium tremens, disturbances in the speech apparatus are distinguished (speech may be too fast, chaotic, or, on the contrary, inhibited, inadequate depending on the patient), often a person conducts conversations with himself or with something or someone he sees only him.
Remember! The patient's behavior in this case is unpredictable. A person can suddenly throw himself out of a window, grab a knife, do absolutely anything.
His actions are explained strong fear and reduced pain threshold. The patient only wants to get rid of obsessive hallucinations or carry out the order of the voice he hears.
Help at home with medications
If delirium tremens has developed, treatment at home is in principle possible, if you rely on the advice of a doctor or the Internet. Of course, it is best to consult a doctor, but the patient himself does not always agree to his hospitalization, and it is not always easy to call specialists who could take the person to the hospital without harming him.
So then how to treat delirium tremens without leaving home? One of the main ways to help is the Popov method, which is based on a combination of three main components.
First of all, the patient is given 2-3 tablets of Phenobarbital. This sleeping pill will eliminate the agitation inherent in patients with delirium tremens and reduce the level of anxiety. Add 15-20 g of alcohol to Phenobarbital medical type, having a concentration of 96% and 100-150 g of ordinary distilled water.
This combination will help, if not cure delirium tremens completely, then at least smooth out its symptoms and wait for the opportunity to contact specialists.
Interesting! Today, not everyone can easily find Phenobarbital at home, and pharmacies do not dispense the drug without a prescription. If this drug is not in the medicine cabinet, you can safely replace it with any sleeping pill that you can find!
Folk remedies in the fight against delirium tremens
On the Internet you can find many ways to cure delirium delirium, and all of them can be used if it is - folk remedies. For example, the following remedies will help treat delirium tremens at home:
- keep a tincture of laurel leaves and lovage root for seven days, and then carefully filter and give a few drops to the patient daily (thanks to this remedy, it will be possible to develop a strong aversion to alcohol);
- you can use a tincture prepared from white wormwood and yarrow in alcohol to induce in the patient a persistent feeling of aversion to alcoholic beverages and relieve the symptoms of delirium tremens without leaving home;
- You can mix yarrow, thyme and wormwood in a ratio of 1:1:1 and brew the mixture with 200 g of boiling water, and then give it to the patient to drink (such a mixture can bring the patient to his senses, literally breathe new vitality into him).
If alcoholic delirium has developed, treatment at home must be carried out very carefully.
Remember! It is necessary to monitor the patient’s condition and, if he develops any negative symptoms(hallucinations intensify, he loses consciousness, convulsions appear), you need to call an ambulance.
Frequently Asked Questions
If delirium tremens develops, how to treat it is not the only question that may torment the patient’s relatives. People often wonder how long does this patient’s condition last on average? Alcoholic delirium can last for several days, in rare cases it lasts a whole week.
Remember! Symptoms of the pathology usually intensify in the evening, being especially annoying at night, and weaken by the morning.
Can this condition resolve on its own, without the help of doctors? If delirium tremens can be identified at an early stage, and the patient listens to the advice of relatives, then there is a possibility that the pathology will not progress.
Is it possible to die due to delirium delirium? Yes, alcoholic delirium is a dangerous condition not only for health, but also for life. About 12% of cases of the development of this pathology end in death, which can be not only a consequence of suicide, but also the result of severe alcohol intoxication and untimely provision of specialized care.
The development of alcoholic delirium is always bad sign, indicating that the human body is no longer able to fully cope with alcohol intoxication. If a person has developed delirium tremens once, then his risk of encountering this pathology again increases significantly as soon as he returns to drinking alcohol. Therefore, it is important to stop drinking alcoholic beverages as soon as possible. If it is difficult to cope with addiction, then resources from the Internet can help.
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Chronic alcoholism is a terrible disease that affects not only internal organs and systems, but also a person’s mental health. Against the background of alcohol dependence, various pathologies and chronic diseases, happens social degradation personality. Often, not only alcoholics suffer from this, but also those people who live with them under the same roof.
One of the most severe and dangerous diseases that occurs with prolonged alcohol consumption is delirium tremens, best known as “delirium tremens.”
Why does delirium delirium occur? How is it different from other psychoses? How is this disease treated and what could be the consequences of delirium tremens?
What is delirium tremens?
In chronic alcoholism, especially in late stages, the occurrence of delirium tremens is only a matter of time. One way or another, this disorder will develop in any case. Most often it occurs after, when the patient abruptly refuses alcohol, when the so-called.
Contrary to popular belief, delirium tremens does not occur during alcohol intoxication. It develops approximately on the second to fourth day after stopping drinking alcohol. In men and women, this disease occurs almost the same. The only difference is that women are most susceptible to the effects of alcohol and drink too much earlier. This means that the attack of the “squirrel” will visit them earlier than the drinking man.
Characteristic manifestations of delirium are: elevated temperature, pallor, or, conversely, redness of the skin, severe tremors of the hands and muscles. The patient constantly suffers from insomnia or nightmares, he is subject to unreasonable aggression, unreasonable fears and panic.
What is the cause of the disease? When drinking alcohol every day, significant damage is caused to the central nervous system, and the brain suffers the most. But over time, alcohol changes the usual metabolism and the body begins to function differently. Therefore, at the moment of abrupt refusal, everything metabolic processes are disrupted, which negatively affects the processes of excitation and inhibition in the brain.
In addition, as a result of alcohol abuse, toxins accumulate in the body in huge quantities, which disrupt the functioning of the brain and central nervous system.
There are cases of delirium tremens after a single use large quantity alcohol, if the person has not drunk at all before. This happens especially often when, instead of high-quality alcohol, its surrogates or cheap low-grade counterfeits are used.
Alcoholic delirium develops gradually, and the severity of its symptoms is directly dependent on the patient’s health status, his alcoholic “experience” and the amount of alcohol consumed.
Withdrawal syndrome and its signs
Alcohol addiction is a very insidious disease. The patient cannot stop drinking, even knowing that he is harming his own body. And if this desire appears, withdrawal syndrome begins, which also brings terrible suffering to the alcoholic. Abrupt refusal of alcohol, especially after a long binge, entails the appearance of withdrawal syndrome, which has nothing to do with a hangover.
For quick and reliable relief from alcoholism, our readers recommend the drug "Alcobarrier". This natural remedy, which blocks cravings for alcohol, causing a persistent aversion to alcohol. In addition, Alcobarrier triggers restoration processes in organs that alcohol has begun to destroy. The product has no contraindications, the effectiveness and safety of the drug has been proven by clinical studies at the Research Institute of Narcology.
At severe syndrome During withdrawal, the patient is also very often tormented by insomnia and clouding of consciousness. This condition is characterized by severe tremors of the arms and legs, which begin almost immediately after stopping drinking alcohol. An uncontrollable craving for alcohol appears: you want to drink at all costs in order to save yourself from this torment. In such situations, it seems to the patient that only alcohol will help him get the long-awaited peace. But when drinking even a gram, the symptoms intensify significantly, which further complicates the alcoholic’s condition.
In severe cases of withdrawal syndrome, various types of hallucinations and seizures also often appear. This is why withdrawal symptoms are often mistaken for the onset of delirium tremens. However, unlike the “squirrel”, hallucinations during withdrawal do not carry a threatening connotation and are more plausible than during delirium.
Who is at risk
Alcohol delirium develops mainly in older people; men over forty who have been drinking alcohol regularly for five to seven years are most susceptible to it. In women, this disease develops much faster.
The following categories of people are most susceptible to delirium tremens:
- women and men who have already experienced a similar attack once;
- chronic alcoholics with experience of five years or more;
- persons who have suffered inflammatory diseases of the brain or traumatic brain injury;
- people with chronic infectious diseases in the acute stage.
Symptoms and signs of delirium tremens
The disease begins literally a couple of days after stopping drinking alcohol. Reviews of people who have gone through this say that the surest sign of the onset of delirium is a sharp refusal of alcohol and an aversion to alcohol. This is followed by emotional instability, and the attack itself begins with severe tremors of the limbs. Later, attacks of insomnia begin, and if the patient still manages to fall asleep, he is haunted by nightmares that make sleep intermittent and restless.
Other symptoms of delirium tremens include:
- unreasonable attacks of fear and panic attacks
- disorientation in time and space;
- rapid heartbeat;
- visual hallucinations, which most often contain images of insects, small animals, werewolves, devils and other fantastic creatures;
- the patient feels as if he is entangled in ropes or caught in a web from which he is unable to get out;
- auditory hallucinations, when the patient hears extraneous sounds, noises, rustles, voices, cries for help, screams of horror;
- such a condition makes a person dangerous not only for himself, but also for those people who live next to him, this especially affects children;
- tactile hallucinations, in which the patient feels the touch of insects on his skin: spiders, ants, and there are also sensations of torture and bullying, delivering phantom pain and suffering to the patient;
- changes in movements, gestures and facial expressions that clearly express everything that happens to the patient in at the moment: horror, fear, pain, disgust - all this is largely reflected in the emotions on the patient’s face.
Alcohol delirium is very dangerous mental disorder, and in no case should it be considered just one of the pathologies of alcohol dependence, which does not cause any harm to the body. The consequences of delirium tremens are very serious and can even threaten the patient's life.
Here are some of the scary situations that can happen after an attack of delirium:
- chronic delirium;
- coma;
- death.
Death from delirium tremens occurs due to many reasons:
- suicide under hallucinatory delusions;
- accident - not understanding where he is and what he is doing, a person can get run over by a car or fall out of a window;
- pulmonary edema;
- respiratory arrest;
- heart failure;
- cerebral edema.
Numerous reviews of people who have experienced an attack of delirium tremens claim that its consequences are so severe for both the patient himself and his loved ones that this serves as the first impetus for getting rid of alcohol addiction. Such mental anguish as after delirium makes life simply unbearable.
An attack of delirium tremens causes serious disturbances in the functioning of organs and systems of the body. And after it, the patient’s condition is significantly weakened. Each subsequent attack significantly increases the risk of cerebral edema, which entails adverse consequences for a person.
Another complication caused by delirium is Korsakoff's psychosis, which usually develops in the severe stages of delirium tremens. Due to extensive brain damage, the patient begins to experience amnesia: he does not remember family members, does not recognize acquaintances, constantly asks the same thing, does not know what happened to him, gets lost in dates and days of the week. A person in this state is characterized by increased excitability and anxiety, often turning into complete indifference to own life. Paralysis and loss of performance are common in these cases.
With Korsakov psychosis, the patient becomes disabled. The performance of such people is no longer restored. But memory may return in a few years, but this will require a complete abstinence from alcohol and high-quality, timely treatment.
Also, the most common, but by no means pleasant, consequences of delirium are mental and social degradation of the individual. It only takes a couple of attacks to lose your mind, and this process is irreversible, since alcohol abuse causes massive destruction of brain neurons. A small dose is enough to have a negative toxic effect on the brain, and with chronic alcoholism, a huge amount of such toxins is produced daily.
Delirium can develop after a small binge or after several months of alcohol abuse. Ultimately it all depends on the quality of the alcohol, genetic predisposition and human health status. Addiction to alcoholic beverages is often inherited.
You should know that after the first attack of delirium tremens, subsequent ones will not keep you waiting, and they can develop even after a small amount of alcohol. Symptoms repeated attack appear much stronger and more severe than when first diagnosed.
A mild or moderate attack of delirium in a hospital setting, as a rule, passes without serious complications, but this requires timely qualified treatment. But in order to prevent a possible recurrence of delirium tremens attacks, it is necessary to completely stop drinking alcohol.
Severe stages of the disease can lead to the development of the following phenomena:
- amnesia;
- chronic alcoholic psychosis;
- various mental disorders;
- psychoorganic syndrome;
- stroke or heart attack;
- liver cirrhosis;
- cerebral edema.
Any of these complications can be fatal.
Help with alcohol delirium
Self-medication in such cases can cost the patient his life. With alcoholic delirium, only qualified medical care can save you.
When the first signs of delirium tremens appear, you must immediately call an ambulance and carry out a series of first aid measures.
It is advisable to put the patient to bed, even tie him up if necessary, give him plenty of fluid, preferably mineral water, to restore the water-electrolyte balance in the body. Try to calm the patient, but do not give any sedatives, as this may cause negative consequences and harm the patient. This condition must be treated in specialized clinics under the supervision of specialists.
Treatment of alcoholic delirium in a hospital involves taking the following medications:
- diphenhydramine;
- barbamyl;
Delirium tremens never goes away without a trace. It’s just that in some situations the consequences of an attack may be less pronounced. This is typical for mild and medium degree diseases. In severe stages, complications caused by attacks lead to very terrible and serious consequences for human health, including coma and even death. It should be remembered that alcoholic delirium of any severity is treated exclusively in a hospital setting or specialized clinic. Self-medication in such situations can lead to the death of the patient.
Every drinker should know about all the symptoms and consequences of delirium tremens. Typically, such psychosis occurs a few days after the end of long drinking bout.
External symptoms of delirium tremens
If you look closely at a person's behavior, it is easy to recognize the symptoms of delirium tremens. Sick starts complaining about the insects around him, which seem to crawl all over the body. Over time, complaints appear about extraneous voices that call and tease the drinker.
If the patient is not provided in time medication assistance, he begins to see corpses everywhere, and thinks that he is being pursued by bandits or monsters. In all cases, the type of hallucinations is different, but they are always present. Be sure to listen to the patient’s sudden complaints.
If you notice any of these signs of fever in your loved ones, take the person to the doctor immediately.
Signs of delirium tremens can also be recognized by changes in the behavior of a drinker. If he suddenly became too talkative, began to remember events many years ago with incredible accuracy, you should take a more serious look at him. Delirium tremens can also manifest itself as intense jealousy towards people who until recently were practically indifferent. Alcoholics begin to do rash and dangerous things, which, in their opinion, shows everyone their courage and heroism. This condition is characterized by sudden mood swings, when excitement is replaced by peace, anger by intense joy, aggression by good nature.
Male symptoms of fever
Most often, delirium tremens occurs in men. The fact is that their psyche is more susceptible to monumental changes. It is possible to recognize the signs of this psychosis in the stronger sex even early stages. This is usually indicated by:
- seizures excessive sweating and trembling in the limbs;
- a sharp loss of interest in alcoholic beverages, and even aversion from it may occur;
- insomnia, which gives way to terrible dreams, from which it is difficult for the patient to wake up;
- frequent mood swings, attacks of increased agitation.
If drug therapy for delirium tremens is not started in time, complications may occur. If the problem is ignored, delirium delirium can cause sudden death. Delirium tremens is a form of serious psychosis, in which the drinking person becomes dangerous to everyone around him. To avoid negative consequences, immediately contact your healthcare professional if there is a sudden change in the drinker’s behavior. He will also be able to approximately say how long they live after this.
Female symptoms of delirium tremens
Female alcoholism is much more difficult to treat with medication. The fact is that addiction in the weaker sex develops more slowly, but more seriously. Women experience not only a physical craving for alcohol, but also a psychological one. It is no longer possible to cope with this problem on your own when delirium tremens appears; emergency medical care is necessary.
An attack of this disease can be recognized by the following signs:
- attacks of aggression;
- increased anxiety;
- frequent mood swings;
- neurological disorders: headache, tinnitus, speech disorders;
- loss of appetite;
- loss of spatial orientation;
- sleep disorders;
- tremor of the limbs;
- increased sweating;
- dehydration of the body;
- high body temperature for a long period;
- increased heart rate and increased blood pressure;
- delusional disorder;
- hallucinations of any kind;
- cramps at night.
The presence of several of the above symptoms in a heavy drinker indicates delirium tremens. We strongly recommend that you do not waste time and immediately contact your doctor. This is the only way to avoid serious consequences of this condition, as well as normalize the functioning of the body.
Hallucinations are a serious psychological disorder that requires immediate attention to your doctor.
Believe me, you will not be able to cope with this without qualified medical assistance. Only a doctor will determine the extent of the damage and the most effective therapy.
Hallucinations during delirium tremens
Hallucinations during delirium tremens do not occur immediately, they are formed when long absence drug therapy. It is also preceded by dramatic change signs: insomnia gives way to serious nightmares, apathy gives way to serious aggression. However, in most cases, this disorder is recognized after the appearance of hallucinations:
| Species | Description |
| Visual | The patient begins to see small animals everywhere, most often insects. However, there may be intense fears that larger predators are after them. Animals are constantly trying to attack, fight or talk to humans. |
| Auditory | There are extraneous voices in the patient’s head that behave extremely aggressively. They insult the person, while the patient constantly responds to them. In the event of a serious defeat, inner voices begin to issue dangerous orders. |
| Tactile | The person begins to feel pain throughout the body and complain of foreign objects in the mouth. At the same time, a person tries to knock off foreign creatures. |
If you do not start therapy, hallucinations begin to give way to illusions. A person can no longer distinguish the real world from the fictional one, which is why he puts not only his life in danger, but also everyone around him. He also has delusional ideas about saving the whole world and humanity, he thinks through a whole plot and begins to behave inappropriately towards others and do dangerous things.
Social consequences of delirium tremens
Delirium tremens is a serious psychological disorder, which can be recognized in the initial stages. It should be noted that this problem does not always go away without a trace. It leaves behind, albeit mild, but still consequences. Because of inappropriate behavior a drinking person can harm not only himself, but also those around him. Many people, due to prolonged hallucinations, commit suicide or attempt to kill other people. If a problem is noticed in time, it can be avoided mild consequences. Typically, after delirium tremens, the patient experiences:
- retrograde or anterograde amnesia;
- psychoorganic syndrome;
- development of chronic psychosis;
- excessive susceptibility to mental disorders.
People who have experienced delirium tremens often experience serious liver and kidney diseases, heart function is disrupted, and the risk of developing cerebral edema increases. It should be noted that such consequences are formed not from the fever itself, but from long-term use alcoholic drinks. To reduce the negative consequences of this problem, it is best to seek help from a specialized medical center, and not limit yourself to therapy at home.
Consequences of severe delirium tremens
No doctor can say exactly how long people live with delirium tremens. It all depends on the duration of use alcoholic drinks , as well as the degree of brain damage.
The consequences of delirium tremens can vary widely: some people experience no serious consequences at all and recover completely, while others suffer serious defects and soon face death.
According to statistics, Every year about 10% of drinkers die from delirium tremens.
How formerly man with delirium tremens will receive medical help, the higher the chance of avoiding serious consequences.
If you believe crime reports, then the vast majority of murders at home occur precisely because of alcoholic delirium. A man having a seizure uncontrolled aggression, can no longer control himself. Because of this, his behavior becomes inadequate, he begins to attack even his close people. However, when he wakes up, he will not remember a single action from yesterday. With the development of prolonged delirium tremens, the alcoholic loses his chances of survival - he develops serious cerebral edema, heart disease develops, and the liver decomposes.
0The phrase “delirium tremens” is probably known to everyone. This disease is very scary. It has serious symptoms, no less serious consequences, sometimes even But at the same time, it is one of the most popular topics in jokes, humorous stories, and tales. What is delirium tremens? What is the reason for this ambiguity? How does it arise and how does it go?
Delirium tremens is a consequence of prolonged alcohol abuse. In Latin it sounds like “delirium tremens”, which translates as “shaking darkness”. In medicine, delirium tremens is also called “alcoholic delirium.” People mostly use the terms “squirrel” or “squirrel”.
General information
Delirium tremens is a consequence of alcohol abuse. “Squirrel” in most cases is observed in experienced alcoholics. These people have second or third degree chronic alcoholism. Typically, such people have already had a drinking experience of 5-7 years. However, there have also been cases when “squirrel” was observed in patients who went on a binge for two to three weeks. There have even been recorded cases of alcoholic delirium in those people who are not dependent on alcohol and do not go on binge drinking. “Squirrel” can come after drinking a huge amount of alcohol, in other words, when a person has had too much. Often the cause of delirium can be low-quality alcohol.
At its core, “squirrel” is the body’s reaction to a lack of alcohol after a long binge. To put it simply, this is a breakdown. As a rule, the “squirrel” visits a person 2-5 days after he has stopped drinking alcohol. During a binge, the brain gets toxic damage. When the supply of new portions of alcohol is stopped, it is observed oxygen starvation. Delirium tremens develops gradually. This often depends on the physical and mental health of the patient.
Symptoms of alcoholic delirium
How does delirium tremens manifest? Symptoms, consequences - we all know this thanks to the work of scientists and doctors. First, let's highlight the main symptoms.
The first symptoms of “squirrel” are disturbances in a person’s sleep. He sleeps very poorly or cannot sleep at all, there is some anxiety. This condition may be accompanied by migraines, convulsions, vomiting, and speech impairment. At the next stage, there is an increase in anxiety, heart rate increases, blood pressure and body temperature rise. The patient's hands shake violently.
Gradually, “glitches” begin - first I have nightmares, and then they develop into some kind of visions. A person experiences deception of hearing and vision while awake: he hears extraneous voices of people, shadows, and various non-existent objects. He sees conspiracies against him everywhere and claims that his life is in danger.
After 2-3 days, the patient’s condition becomes even worse: he does not sleep at all, he already imagines various insects crawling over his body, fairy-tale animals, devils, elves, gnomes. The patient tries to escape from the threat. This state may leave him in a couple of days, or it may end more disastrously for himself and for the people around him.
Let us highlight the following main symptoms of alcoholic delirium:
- visual and auditory hallucinations;
- state of madness and insanity;
- loss of orientation in space and time;
- chills, increased blood pressure and temperature;
- anxiety, fear, severe nervous excitement;
- frequent mood changes: aggression and fear change to fun, and vice versa;
- or general insomnia;
- increased sweating;
- hand tremors, convulsions;
Varieties of delirium tremens
The following types of “squirrel” can be distinguished:
- Reduced delirium- short-term or mild “squirrel” symptoms.
- Atypical mixed delirium- “glitches” are added to mild symptoms, the orientation and sense of reality are lost. This type of “squirrel” can end abruptly or be lytic in nature, that is, gradually. In the latter case, delusional ideas persist for a very long time.
- Severe delirium- can develop in two directions: mumbling and professional.
Types of severe delirium
Mumbling delirium— the patient constantly mutters something indistinctly and makes strange movements: palpating, wiping, smoothing. Dehydration is also common.
Occupational delirium diagnosed by movements that predominate in a person’s work environment. In this case, the patient is sure that he is at work. He makes all the movements and repeats the same sounds as in his workplace. Usually this condition develops into Korsakov psychosis.
Korsakov psychosis
Korsakov psychosis is a mental disorder resulting from the defeat of Delirium tremens, the consequences for the brain are extremely disastrous. The patient experiences amnesia - the patient forgets absolutely everything, he does not remember the past, and is not even able to reproduce the events of the current day. Such people do not remember the names of their loved ones, they may ask the same stupid questions, etc. Patients are very anxious, they are afraid of everything. Over time, they may develop a state of euphoria or, on the contrary, apathy and indifference. With Korsakov psychosis, the ability to work is lost and paralysis develops. The patient becomes disabled. With complete abstinence from alcohol and intensive rehabilitation After 2-3 years, memory may stabilize, but performance does not return.
First aid for delirium tremens
If a person has squirrel symptoms, first of all, you should try to put him to bed and keep him in that position until the doctors arrive. You need to apply something cold to your forehead and give him plenty to drink. The patient needs to calm down. For this purpose, you can give sedatives or sleeping pills. A patient in the “squirrel” state must be under constant supervision for the safety of both him and those around him. In a state of delirium, a person, running away from an imaginary danger, may lean out of the window or begin to fight with improvised means, and these can be very dangerous objects.
Treatment of delirium tremens
Delirium tremens is a consequence of drug abuse. It is impossible to overcome the “squirrel” on your own, so medical care is mandatory. The patient must be hospitalized in psychiatric hospital. Refusal medical care may be fraught with consequences. The state of alcoholic delirium usually lasts from two to eight days. During the day the patient feels better, he even reminds normal person, but at night the symptoms worsen.
To treat squirrels, psychotropic sedatives are used, as well as agents that normalize metabolism and water-salt balance in the body. Doctors bring the cardiovascular system and breathing back to normal. Vitamins must be administered intravenously. If the patient has prolonged hallucinations, antipsychotic drugs are prescribed. However, they are not always prescribed, only in emergency cases, as they tend to intensify seizures. After recovery, the patient is prescribed long-term preventive treatment with limited alcohol consumption or complete abstinence. Delirium tremens still leaves consequences after treatment - even the best one. But in what form is another question.
Consequences
What delirium tremens is and what its symptoms are has already become clear. Now let's look at the consequences. All human organs and systems suffer from alcoholic delirium. Delirium tremens can have consequences ranging from complete recovery to death. Most often, this is a manifestation of a variety of diseases, both physical and mental. The consequences depend on how good health the patient has. The degree and timeliness of first medical aid plays an important role.
Here are some consequences of delirium:
- psychosis in chronic form;
- disruption of the heart;
- deterioration of blood circulation;
- kidney diseases;
- liver diseases;
- cerebral edema;
- amnesia.
In most cases, patients who are lucky and have overcome the “squirrel” tend to full recovery and do not repeat the sad experience. These people become very sensitive: even minor consumption can trigger a new attack, which will be stronger. The consequences of delirium tremens after binge drinking can already be fatal. Then it is almost impossible to save a person.
