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Old 04-13-2012
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Question DT and alcohol withdrawal

what is the difference between delirium tremens and alcohol withdrawal , I know they are the same , and DT is associated with life threatening condition , but what is the difference???
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Delirium tremens
This is a medical emergency. A hyperadrenergic state is present.

Clinical features
Delirium tremens usually begins 24-72 hours after alcohol consumption has been reduced or stopped. The symptoms/signs differ from usual withdrawal symptoms in that there are signs of altered mental status. These can include:
  • Hallucinations (auditory, visual, or olfactory).
  • Confusion.
  • Delusions.
  • Severe agitation.
  • Seizures can also occur.
  • Examination may reveal signs of chronic alcohol abuse/stigmata of chronic liver disease. There may also be:12
  • Tachycardia
  • Hyperthermia and excessive sweating
  • Hypertension
  • Tachypnoea
  • Tremor
  • Mydriasis
  • Ataxia
  • Altered mental status
  • Cardiovascular collapse

Acute alcohol withdrawal
Acute alcohol withdrawal can be a complex issue. Some patients have mild symptoms and can be managed in the community; others have more severe symptoms or a history of adverse outcomes and need close inpatient supervision.
This may be in a number of different ways:
  • A patient may present in acute alcohol withdrawal.
  • A patient may be admitted to hospital for another reason and thus an unplanned alcohol withdrawal may be precipitated. Alcohol-use disorders can complicate the assessment and treatment of other medical and psychiatric problems.
  • A patient may present wishing to abstain from alcohol but be seen as at risk of acute alcohol withdrawal.

Withdrawal symptoms:
Symptoms typically present about 8 hours after a significant fall in blood alcohol levels. They peak on day 2 and, by day 4 or 5, the symptoms have usually improved significantly.

Minor withdrawal symptoms (can appear 6-12 hours after alcohol has stopped):
  • Insomnia and fatigue.
  • Tremor.
  • Mild anxiety/feeling nervous.
  • Mild restlessness/agitation.
  • Nausea and vomiting.
  • Headache.
  • Excessive sweating.
  • Palpitations.
  • Anorexia.
  • Depression.
  • Craving for alcohol.
  • Alcoholic hallucinosis (can appear 12-24 hours after alcohol has stopped): Includes visual, auditory, or tactile hallucinations.
  • Withdrawal seizures (can appear 24-48 hours after alcohol has stopped): These are generalised tonic-clonic seizures.
  • Alcohol withdrawal delirium or 'delirium tremens' (can appear 48-72 hours after alcohol has stopped).

SOURCE: http://www.patient.co.uk/doctor/Acut...um-Tremens.htm
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Old 04-13-2012
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sounds like a nice plan for the next Monday!
Ambition is a dream with a V8 engine. EP
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In short, DT is a complication of alcohol withdrawal. For Step 1 purposes, the biggest differentiator is hallucinations (especially tactile hallucinations, such as the feeling of bugs running up your skin). If a patient is hallucinating, then they've progressed from regular alcohol withdrawal to DTs.
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Alcohol withdrawal syndrome is an umbrella term for delirium tremens.
Other problems are:
  1. Mild Withdrawal
    (6h after last drink: anxiety, tremulous, sewating)
  2. Withdrawal seizures
    (12h after last drink)
  3. Alcoholic hallucinosis
    (18h after last drink: aufitory, visual, tactile)
  4. Delirium tremens
    (48h after last drink: fever, hypertension, tachycardia, hallucinations, 5% mortality rate - treat with benzodiazepines)

Maybe this helps.
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