Alcohol withdrawal and delirium tremens

Meet the patient

Bed 12 is a 58-year-old woman, day two after an elective hemicolectomy. The nursing note says "anxious, poor sleep, wants to go home". Her hands are shaking and her pulse has been 105 to 118 all morning.[7][8]

Her pre-admission questionnaire recorded "occasional wine". Her last drink was Sunday evening. It is now Tuesday lunchtime.[8][11]

She is roughly forty hours out and sitting inside the seizure window. Nothing about the next six hours is behavioural. This topic is the clock, the drug and the dose that keep her out of the ICU.[8][11]

Examiners fail candidates on three things here: the wrong timeline after last drink, underpowered benzodiazepine cover for evolving delirium tremens, and a missed Wernicke encephalopathy while the candidate chases a psychiatric label.[7][8][14]

References16Show ledgerHide ledger

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13. [13]Ferguson JA, Suelzer CJ, Eckert GJ, et al. Risk factors for delirium tremens development. J Gen Intern Med, 1996.PMID 8842933
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