From the Guidelines
This patient requires admission due to the high risk of recurrent delirium tremens (DTs) and other severe complications, despite being sober for 2 years, as their history of DTs and seizure significantly increases the risk of severe withdrawal symptoms. The patient's history of delirium tremens, a severe form of alcohol withdrawal syndrome, is a significant risk factor for recurrent DTs, which can be life-threatening with mortality rates of 1-4% even with treatment 1. According to the French Association for the Study of the Liver and the French Alcohol Society clinical guidelines, symptomatic alcohol withdrawal is based on treatment with benzodiazepines until symptoms disappear, and the presence of a decompensated liver disease requires prioritization of a personalized prescription that is symptom-adapted and favors short-acting drugs 1.
Key considerations for this patient's management include:
- Close monitoring for signs of withdrawal and seizure
- Controlled detoxification to prevent progression to severe withdrawal complications
- Potential use of short half-life benzodiazepines, such as oxazepam or lorazepam, to avoid drug accumulation in patients at risk of developing encephalopathy 1
- Prescription of thiamine to prevent the onset of Wernicke's encephalopathy, given the high prevalence of thiamine deficiency in alcohol-dependent individuals 1
While the patient has been sober for 2 years, their history of DTs and seizure, combined with the current presentation, indicates a high risk for severe withdrawal complications, making admission necessary for proper management and monitoring 1.
From the Research
Patient Assessment
The patient has a history of delirium tremens (DTs) and seizure, and has been sober for 2 years after consuming 6 packs of alcohol. The risk of recurrent delirium tremens (DTs) or other complications such as tachycardia needs to be assessed.
- The patient's history of DTs and seizure indicates a high risk of severe alcohol withdrawal syndrome 2
- The patient's long period of sobriety (2 years) may reduce the risk of recurrent DTs, but the risk is still present due to the patient's history of DTs 3
Risk Factors for Delirium Tremens
Several risk factors for delirium tremens have been identified, including:
- History of DTs 2
- History of seizures 2, 4
- Chronic heavy drinking 2
- Low platelet count, high blood level of homocysteine, and low blood level of pyridoxine 4
Management of Delirium Tremens
Delirium tremens should be managed at an ICU or wards ensuring vital signs monitoring 3
- Benzodiazepines, especially lorazepam, diazepam, and oxazepam, are considered the gold standard drugs for symptomatic treatment of DTs 3, 5, 6
- Supportive therapy, including hydration and electrolyte management, is also important 3, 6
Admission Decision
Based on the patient's history and risk factors, admission to a hospital for monitoring and management of potential complications is recommended.