Signs of alcoholic delirium are: Manifestations of alcoholic delirium

Alcohol delirium is the most severe manifestation of alcohol withdrawal syndrome. Mortality is 5-15%. It usually develops 2-4 days after stopping alcohol intake and lasts, as a rule, 3-5 days. Along with the symptoms of alcohol withdrawal syndrome indicated in the previous chapter, hallucinations, confusion, loss of orientation, fever, and profuse sweating appear.

Problems in providing assistance

A delirious patient poses a danger to himself and to others due to the unpredictability of his behavior. The patient may commit attacks on others, suicide, or actions due to hallucinations or delusions.

Attention. It is necessary to exclude a wide range of other diseases that may have similar clinical manifestations:, meningitis, tuberculosis, pneumonia, etc. Healthy alcoholics have been rare in recent years; delirium often develops against the background of an existing illness, making it worse.

Survey

Consultation with a psychiatrist, neurologist. Laboratory examination includes general analysis blood, blood ethanol level, blood and urine electrolytes (potassium, sodium, magnesium), urea, creatinine and blood glucose, blood enzymes (ALT, AST). Instrumental examination: chest x-ray, pulse oximetry.

Treatment

The problem of safety of the patient and department staff. The patient must be well fixed in bed; it is required constant surveillance for the sick. These patients have a very bad habit of dying suddenly (usually due to heart rhythm disturbances). Therefore, kits for intubation, mechanical ventilation and resuscitation of the patient should be located next to the patient in an unfolded form.

Treatment alcoholic delirium in the ICU

There are two main approaches to treating these patients in the ICU:

The first is deep sedation and transfer of the patient to artificial ventilation lungs for a period until the cessation of delirium. For the purpose of sedation, sodium hydroxybutyrate, propofol, narcotic analgesics. They try to increase sedation at night and decrease it at night. daytime, i.e. trying to support normal cycle sleep-wake. This approach makes patient care easier. But there is also a significant, difficult to eliminate disadvantage - the growth of purulent, and first of all, purulent respiratory complications (pneumonia, purulent tracheitis, etc.).

The second is when the patient remains breathing spontaneously, and they try to stop the symptoms of psychosis with prescription medicines.

Benzodiazepines

Benzodiazepines are the mainstay of treatment for alcoholic delirium. They are recognized as the most effective and safe drugs in the treatment of this disease. The dose is selected so that the patient’s main manifestations of alcoholic psychosis are stopped, but there is no suppression of spontaneous breathing.

This is not always possible to achieve; in some cases, assisted or controlled ventilation may be required. In patients with liver disease, as well as in those receiving drugs that increase oxidative metabolism in the liver (for example, cimetidine and isoniazid), benzodiazepines should be used with with utmost care. In our country, diazepam is most often used, and phenazepam is used less often. Lorazepam is considered the more effective, safe and most used drug in most countries, especially for patients with liver diseases.

It compares favorably with other benzodiazepines by its short duration of action, low risk of accumulation, and the absence of large active metabolites. In some cases, lorazepam (, lorafen) can be used in oral form. Lorazepam is administered orally or through gastric tube at a dose of 0.1 mg/kg 2-3 times a day.

Depending on the department’s capabilities in organizing patient monitoring, choose one of the following schemes:

A high-dose regimen of benzodiazepines is more effective in terms of stopping the manifestations and “breaking” of alcoholic delirium.

Administration of sufficient initial doses of benzodiazepines reduces the risk of paradoxical arousal (i.e., disinhibition with increased behavioral disorders). Usually, its use does not require additional prescription of neuroleptics and (or) barbiturates. However, its implementation is often complicated by respiratory depression, so good monitoring (pulse oximetry is mandatory) and continuous monitoring of the patient must be established. An indispensable condition is literate medical staff and the ability to initiate immediate action if complications arise.

Attention. Before implementing a high-dose benzodiazepine regimen, carefully consider whether your department meets the requirements listed above. If not, use other treatment regimens for patients.

Alcoholic hepatitis and other liver damage, which are very common in patients who abuse alcohol, limit the use of benzodiazepines.

The following drug administration regimen is proposed:

A small loading dose of diazepam (Relanium) is administered intravenously as a bolus - usually 10 mg or 2 mg of phenazepam;
Then the dispenser begins continuous administration of diazepam at a rate of 0.5-1 mg/min, or - 0.15-0.3 mg/hour;
As soon as the effect of calming the patient is achieved (relief of the main manifestations of delirium), the administration is immediately stopped. Note that the doses of benzodiazepines required to achieve effective sedation vary widely between patients.

If after some time (hours) the patient's agitation increases, the infusion of benzodiazepines is resumed at the rate indicated above. And as soon as sufficient sedation is achieved, the benzodiazepine infusion is stopped. Usually daily dose drugs - at least 60 mg of diazepam, or 20 mg of phenazepam. The elimination period of diazepam and phenazepam is long, so quite often patients do not need repeated administrations these benzodiazepines.

Traditional dosage regimen for benzodiazepines:

10 mg of diazepam (Relanium) or 2 mg of phenazepam are administered intravenously (sometimes intramuscularly), 3-6 times a day;
Due to the insufficient antipsychotic effect, it is almost always necessary to additionally administer antipsychotics (haloperidol, etc.);
Once sufficient sedation is achieved, benzodiazepines are discontinued. This regimen of benzodiazepine administration reduces the risk of respiratory depression, respiratory arrest, and hypotension;

Neuroleptics

Neuroleptics, the main drugs for the treatment of alcoholic delirium in the recent past, are currently used in case of insufficient effectiveness of the above therapy. The fact is that they have a number of disadvantages - they lower the threshold of convulsive readiness and often cause hypotension. The most pronounced hypotensive effect possess phenothiazines (chlorpromazine (aminazine), promazine) and aliphatic thioxanthenes (chlorprothixene). It is somewhat safer to use haloperidol, 2.5-5 mg IV, IM every 2 hours. Start with low doses, increasing them as needed.

Propofol

Propofol is effective in benzodiazepine-resistant delirium tremens. IV bolus of 0.5 mg/kg, then infusion at a rate of 10-75 mcg/kg/min, focusing on the optimal degree of sedation. Its advantages are obvious - high controllability and fast metabolism. But in the vast majority of cases, the use of propofol requires mechanical ventilation.

Dexmedetomidine

A popular sedative drug, the alpha-2 adrenergic agonist dexmedetomidine, is effective in eliminating autonomic symptoms alcohol withdrawal. Doesn't call serious violations hemodynamics and respiratory depression if the rate of administration does not exceed 0.7 mcg/kg/hour. Allows you to reduce the dose of benzodiazepines.

Purpose of alcohol

Prescribing alcohol is considered an outdated method with low effectiveness. In our opinion, there are cases when alcohol should be prescribed in the early stages of alcoholic delirium. When prescribed alcohol on the first day along with benzodiazepines, it can reduce the severity of psychosis, and in some cases, interrupt it. This is especially important if the patient has severe concomitant pathology (for example, severe trauma, ongoing bleeding, recent myocardial infarction, serious surgery and etc.). The use of alcohol is contraindicated in pancreatitis, liver failure. Average dose alcohol per reception - 0.5-1 g/kg. Intravenous administration: 30-50 ml 96% ethyl alcohol per 500 ml of 10% glucose by slow infusion.

Ethyl alcohol infusion is used once a day, usually at evening time, within 1-2 days. If it is known for sure that before the patient developed alcoholic delirium, he used very large doses alcohol, the frequency of alcohol administration can be increased to two injections per day.

Beta blockers and clonidine

Draw 300 mg of ketamine into a 10 gram syringe. An IV bolus of typically 0.5–0.75 mg/kg ketamine is administered to provide a level of sedation to allow initiation of the infusion. The ketamine remaining in the syringe is administered intravenously at a rate of 3 mg/min;
It is not so easy to obtain venous access in a patient with alcoholic delirium and agitation of 7 points according to RIKER. In these patients we used alternative technique administration of ketamine - IM 3 mg/kg;
Ketamine according to the indicated methods is administered once a day. The result is assessed several hours after cessation of administration. If the effect is insufficient, the administration of ketamine according to the same scheme is repeated the next day;

conclusions:

In almost all cases, we observed a decrease in the degree of excitement or interruption of delirium. The method does not require mechanical ventilation. Very rarely, usually after administration of a ketamine bolus, there was a need for short-term assisted ventilation through a mask. It is quite obvious that while ketamine is working, all the necessary therapeutic and diagnostic measures can be carried out.

In any case, the use of ketamine can significantly reduce the doses of benzodiazepines and haloperidol. With comparable, and possibly better, effectiveness, the safety of this technique is immeasurably higher than, say, a high-dose regimen of benzodiazepines. When using ketamine, the patient requires intensive observation for a little more than an hour. When using benzodiazepines - continuously for several days, since their half-life is several tens of hours.

This pathology is also called meth alcoholic psychosis, occurs in people who long time used in large quantities alcohol. Delirium tremens, or delirium tremens, is a serious illness with dangerous symptoms that requires treatment. One of the most striking manifestations is hallucinations, which develop in most patients. This condition requires hospitalization of the patient in a clinic and treatment under the supervision of a doctor.

What is delirium tremens

This is the most common type of alcoholic psychosis among people suffering from alcoholism. As a rule, it develops after 7-9 years of regular drinking, often appearing in patients with stage 2-3 alcoholism. Occasionally, the occurrence of delirium is observed in alcoholic excesses in people who do not suffer from alcoholism. Symptoms always appear after abruptly quitting alcohol and never if a person continues to drink.

Forms of delirium tremens

The development of the disease occurs in stages and may resolve in different ways. Depending on the type of pathology, the treatment regimen and types of drugs for it depend. The following types of delirium are distinguished:

Classical. Symptoms appear gradually; several successive stages of pathology development occur.
Lucid. This type of delirium is characterized by an acute onset of the disease, there are no hallucinations, a delusional state, anxiety, tremors, coordination disorders, and fear are more pronounced.
Abortive delirium. This form is characterized by fragmentary hallucinations, fragmentary, insufficiently formed delusional ideas. The person has severe anxiety. This type can develop into another form of psychosis, and sometimes recovery is noted.
Professional delirium. The development of psychosis begins as in a typical squirrel. Further, delusions and hallucinations are reduced, and repetitive movements that are associated with a person’s work, undressing, dressing, etc. begin to prevail in the clinical picture.
Delirious delirium. This is the next stage, which begins from the professional form, but can sometimes develop from other types of disease. Signs include severe, pronounced clouding of consciousness, somatovegetative disorders, characteristic movement disorders.
Atypical delirium. Occurs in patients who have previously suffered from other forms of delirium tremens, alcoholic psychosis. This type includes symptoms similar to schizophrenia.

Causes

Alcoholism becomes the main and main factor in the development of pathology. TO additional factors should be attributed long-term use, low-quality alcoholic drinks (technical fluids, alcohol surrogates, pharmacological preparations with alcohol), severe pathologies of internal organs. The following factors can also lead to typical delirium:

Traumatic brain injuries have some significance, as does a history of brain disease.
According to doctors, the decisive role is played by chronic intoxication of the body, disorders metabolic processes in the brain.
The likelihood of delirium tremens increases due to severe physical, mental stress, for example, if while intoxicated the patient is injured and ends up in the hospital. Alcohol stops entering the body and develops withdrawal syndrome against the backdrop of a change of environment, discomfort and physical pain, worries about trauma.
A situation similar to the situation described above develops when drunken patients are admitted to a hospital department (cardiology, gastroenterology).
At home, delirium usually develops after abrupt exit from hard drinking against the background of exacerbation of somatic disorders.

Alcohol delirium - symptoms

There are two main types of signs of the development of the disease – somatic and mental. They usually appear together, so doctors give an almost 100% guarantee correct diagnosis. The most a clear sign hallucinations become, in reality the person observes various insects, animals or fantastic creatures. Which fly nearby, crawl over his body. The imagination is so unpredictable that the patient not only sees them, but can also feel the touch. The main danger is that the patient may injure himself due to false sensations.

Physiological

This is one of the types of symptoms that are inherent in alcoholic psychosis. This group includes signs of pathology that are of a direct physiological nature. The following are distinguished: key symptoms this type:

sweating;
hand tremors;
facial redness;
limbs are cold;
Heart rate over 100 beats;
dyspnea;
Blood pressure rises to 180/100;
vomit;
body temperature rises to 40 degrees;
convulsions;
headache.

Symptoms of confusion

This group of signs is associated with delusional disorders, serious brain damage. They appear simultaneously with physiological symptoms and provides a complete picture of delirium. This group includes the following manifestations:

rave;
insomnia, nightmares and other sleep disorders;
tactile, auditory, visual hallucinations;
anxiety;
panicky feeling of fear;
disorientation in space and time;
excessive excitement.

Stages of development of delirium

In the later stages of the disease, it is practically impossible to recover from alcoholic psychosis on your own; this condition requires medical attention. There are several stages of the disease that have specific characteristic. The treatment regimen is prescribed taking into account the patient’s condition, so this is an important diagnostic point. The main stages of the development of alcoholic psychosis (delirium) are described below.

Initial

At the first stage, characteristic disturbances are noted emotional state person. It changes quickly, worry and anxiety are immediately replaced by high spirits, euphoria, then despondency and depression may set in. The patient’s facial expressions and speech remain alive, so the person simply looks worried and nervous. This stage is characterized by the following manifestations:

Any irritants cause severe reaction: smells, sound, flashes of light.
The patient will talk about vivid memories and images that pop up in his mind.
Fragmentary visual and auditory hallucinations are noted.
At night, a person feels severe anxiety, often wakes up, and has shallow sleep.

Stage of appearance of illusions

This is the stage of complete delirium, when all the symptoms of the disease become more pronounced. Marked following signs alcoholic psychosis:

Full-fledged visual hallucinations, auditory and tactile hallucinations are added, in some cases even thermal, olfactory and gustatory.
It seems to a person that they are trying to kill him, that someone is chasing him.
Visual delirium manifests itself in the form of spiders, midges, cobwebs flying around the room, and sometimes images of deceased loved ones appear.
A person feels rats, snakes, small insects crawling on the skin - these are tactile hallucinations.
The above symptom leads to an increase in body temperature, heart rate, and blood pressure.
If the patient has concomitant pathologies, for example, depression, severe trauma, or previous delirium, then the second stage quickly progresses to the third.

True hallucinatory delirium

This is the final stage of the disease, which requires inpatient treatment. Medicinal and physiotherapeutic methods are used for therapy. True delirium has the following symptoms:

The patient ceases to respond adequately to external commands, speech is incoherent and quiet.
There is a decrease of 20% relative to normal blood pressure.
Frequent convulsions occur, the pupils are dilated, breathing is intermittent, trembling occurs throughout the body.
The muscles of the back of the head stop deforming.
In severe cases, the patient falls into a coma, and swelling of the brain tissue may occur, which leads to death.
There is an irreversible disruption of the functioning of many internal organs.

Treatment of alcoholic delirium

This condition requires not only intensive drug therapy, but also constant monitoring of the patient to ensure the safety of himself and those around him. In some cases you need resuscitation measures when providing emergency care. Treatment of delirium must be carried out on the basis of a psychoneurological hospital, under the supervision of a therapist or resuscitator. There is no single point of view regarding the treatment algorithm; many drugs have been proposed that can help the patient with the clinical picture of alcoholic psychosis.

Symptom relief

As soon as clinical manifestations are noticed alcoholic hallucinosis should be called immediately ambulance for hospitalization of the patient. For treatment, a person is sent to a drug treatment or psychiatric clinic, where he can receive the necessary observation and drug treatment. Before the ambulance arrives, it is necessary to place the patient with characteristic mental symptoms in bed and maintain this position for as long as possible. When treating alcoholic delirium, a person should not be left alone for a second.

Sanitary supervision

This required condition when treating a patient with obvious signs of alcohol withdrawal during chronic alcoholism. With abrupt cessation of use, disturbances of consciousness are observed. Delirium attacks are accompanied by autonomic disorders and delusions of persecution, characterized by visual hallucinations that are at odds with reality. This condition can lead to injury to the patient or others. IN medical institution ensure patient safety and treatment control. Typically, two main methods are used:

Deep sedation will be performed, and the patient will be connected to a ventilator until the episodes of delirium end.
The person remains on spontaneous breathing; acute psychosis is relieved with the help of medications.

Drug treatment

Self-medication of withdrawal symptoms is strictly prohibited. An experienced doctor will be able to correctly select the list of necessary medications that will bring the patient’s condition back to normal. If the scheme is drawn up incorrectly, complications may develop. In the hospital, delirium is typically treated with the following groups medicines:

psychotropic drugs;
means for normalizing the respiratory system;
preparations for water-salt balance;
phenotisines for adjusting blood pressure;
remedies for insomnia;
medications to normalize metabolism;
drugs to improve performance of cardio-vascular system;
detoxification medications.

Detoxification of the body

Alcohol intoxication continues to poison the body, so it is necessary to cleanse the blood and internal organs of poisons. Against the background of alcoholism, a person often develops heart failure, damage to the liver, kidneys, and gastrointestinal tract is observed. To cleanse the body, intravenous administration of medications such as Piracetam or Unitol is often used. If diagnostics reveals mental disorders, then use antipsychotropic drugs (Renalum, Tezapam).

Effective method purification of blood from alcohol toxins - plasmapheresis. This is a method of plasma purification; part of it is replaced with special solutions. This helps to achieve maximum detoxification action, which clears the cells of poisons that cause withdrawal symptoms. Plasmapheresis has the following advantages in the treatment of delirium:

normalization of brain nutrition;
improvement rheological properties blood;
high safety of the procedure;
normalization of the immune system;
reducing the duration of treatment for alcoholism;
tangible relief of the patient’s condition during severe abstinence;
relieving the load on the liver;
the risk of exacerbation of pathologies of internal organs is reduced during the treatment of delirium and abrupt withdrawal of alcohol intake.

Additional positive effect achieved by taking the diuretic medications Lasix or Mannitol. It is recommended to use in combination as part of the infusion active remedies. An important component of detoxification treatment are medications that restore and protect liver tissue. These include:

Heptral;
Essentiale.

Stimulation of physiological sleep

For these purposes, medications from the benzodiazepine group are used, which are the basis for the treatment of delirium. In medicine, they are recognized as the safest, most effective medications for therapy at all stages of alcoholism. The dosage is selected individually so that the patient is relieved of all the main signs of alcoholic psychosis, but does not experience depression of spontaneous breathing. These medications help put a person into a state of prolonged sleep if necessary.

In Russia and the CIS countries, Diazeam is more often used, and sometimes phenazepam. In most countries, Lorazepam is considered the safest and most effective, especially if the patient is diagnosed with liver disease. The use of sufficient initial doses of this group of medications helps to avoid severe agitation of a threatening nature. The traditional dosage regimen for benzodiazepines is as follows:

A bolus of 2 mg of Phenazepam or 10 mg of Diazepam is administered 3-6 times a day.
Combine benzodiazepines with antipsychotics due to insufficient antipsychotic effect.
Upon reaching the required sedative effect drug administration is stopped. This avoids depression, respiratory arrest and hypotension.

Neuroleptics for excitability and aggression

This is another main group of medications that is used in the treatment of alcoholic psychosis. IN modern practice used as additional measures if the above-described means are insufficiently effective. This is due to a number of disadvantages of these drugs: they cause hypotension and reduce the threshold for convulsive readiness. The highest likelihood of developing hypotension is observed when taking Promazine, Chlorpromazine. Start taking several doses and increase them if necessary. Examples of such drugs:

Pereziazine;
Propofol;
Benperidol;
Dexmedetomidine;
Clozapine.

Cardiac glycoside

This group medicines that I have vegetable or synthetic origin and are aimed at improving cardiac activity. As a rule, they are used in the treatment of severe cases caused by a disorder contractility myocardium. It manifests itself in the form of wheezing and shortness of breath. These are some of the characteristic signs of withdrawal syndrome, which creates a significant load on the heart muscle. Glycosides become part complex therapy.

Drugs to reduce brain swelling

This is one of the most terrible complications which, if left untreated, can be fatal. Therapy begins after the acute condition, psychosis, is relieved. The following medications are used to treat alcoholic encephalopathy:

neuroprotectors: Actovegin, Cerebrolysin;
nootronics: Elkar, Cavinton, Pantogam;
sedatives: Relanium, Phenazepam;
treatment of alcohol abuse: Colme, Teturam, Esperal.

Consequences of alcoholic delirium

Abrupt refusal in pathological intoxication from drinking alcoholic beverages leads to dangerous consequences. The most dangerous complication swelling of the brain occurs, which leads to death. This can only be avoided with timely diagnosis and medical care. Delirium tremens becomes a catalyst for development various diseases, For example:

pancreatitis;
pneumonia;
renal failure;
alcoholic cardiomyopathy;
rhabdomyolysis;
violation vitamin metabolism;
failure of water-salt balance;
acid-base disorders;
cerebral edema.

Video

Official statistics say that more than 5 million people in the Russian Federation suffer from alcoholism. However, she is silent about how many of the 5 million suffered delirium tremens and how many more people will suffer from it. Alcohol delirium (in colloquial speech"delirium tremens" or "squirrel") - acute psychosis accompanied by aggressive behavior(mainly directed at oneself), delusions and hallucinations. Alcoholics' fever occurs only when they abuse alcoholic beverages, and during this period a person is dangerous to himself and those around him, as he is being persecuted obsessive-compulsive disorder, and he simply has no way to distinguish it from reality.

Alcoholic delirium - medical history

Code F10.4 according to the ICD (10th revision) describes delirium delirium as a syndrome accompanying drunkenness at stages II and III of development. Fever occurs against the background of withdrawal syndrome (on days 3-6), when a person abruptly stops drinking. At the extreme stages of alcoholism, it can also occur during a binge (on 2-3 days).

The diagnosis is made to people who drank daily for a month:

2.5 l of wine;
5l of beer;
or 0.5 liters of stronger drinks.

And also for people suffering from alcoholism for more than 5 years.

Fever manifests itself in delusional states, the root of which lies:

Hallucinations of various types. The visual most often appears in the form of evil creatures of small size, for example, beetles, brownies, demons and the like.
Increased temperature, even chills.
Losing oneself in time and place (disorientation).

Relief of the condition can be observed from time to time even in the absence of medical intervention. The medical history ends in death in only 2-5% of cases. The rest will experience a complete or partial recovery.

Clinical picture of alcoholic tremens: symptoms and signs

Symptoms appear after 72 hours from the last dose of strong drinks consumed.

However, if sudden withdrawal was preceded by any damage, surgery, etc., then signs may appear on the first day.

Consider in more detail clinical picture it is possible by dividing the state into stages of development, of which there are 3.

Stage 1. Threatening delirium

In general, this period is identical to withdrawal syndrome.

Morning symptoms are reflected in both physical and mental state:

loss of sense of time and orientation even in familiar places;
hyperthermia (temperature increases up to 39);
increased breathing and heart rate;
sudden occurrence;
repeated vomiting;
diarrhea.

In the evening the following appear:

hallucinations various types;
growing excitement;
or nightmares.

Resuming drinking alcohol at this stage can return the patient to his normal state.

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Along with paresthesia, a person may be bothered by the so-called carpal tunnel syndrome wrists. you will read what folk remedies are used to treat it.

Stage 2. Complete acute delirium

At this stage, spontaneous healing is impossible.
Symptoms develop very quickly.

The clinical picture looks like this:

The hallucinations increase in intensity, become more terrible, and their duration increases.
The delirium intensifies and becomes intrusive. The patient feels as if someone is chasing him/wants to kill him.
The temperature increases to above 39.
Increased sensitivity to external stimuli(light, sound and others).
General excitement abruptly gives way to aggression and vice versa.
The respiratory rate increases to 26 per minute.

Without medical care the condition quickly moves into the final stage.

Stage 3. Life-threatening delirium

Extreme fever has the following symptoms:

Apathy that replaced aggression.
Lethargy, weakness.
Decreased all reactions.
Extreme degree of delirium. Shattered and incoherent speech, quiet voice.
Tremors that spread to the whole body, convulsions, etc.
Shortness of breath due to tachycardia.

If you do not consult a doctor, the depression of consciousness can reach a coma.

The last stage entails irreversible changes brain, and only the time of assistance affects how extensive they will be. If treatment is not provided on time, death will occur from cerebral edema or hemorrhage into it.

Causes of alcoholic tremens

The most common misconception is that fever occurs due to prolonged drinking, as a result of intoxication.

In fact, there may be several reasons:

Sudden stop in drinking alcohol.
Drinking too much.
Damage to the body (especially).

Diagnosis of alcoholic delirium

Differential diagnosis is complicated by the fact that, along with alcohol, there is the use of other drugs.

The main signs for diagnosing fever are:

The patient's agitation is less than with classic delirium.
Hallucinogenic delirium, which affects the patient’s actions to a lesser extent than in classic delirium.
Excitement that does not spread beyond familiar terrain (in the severe stage - bed).
Hallucinations and delusions influence the patient’s actions to a lesser extent.
Strong feeling of hunger/thirst.
Trembling, spreading throughout the whole body.

Emergency diagnostics

Emergency diagnosis can be carried out using a simple test:

If the patient scores less than 23 points, then it is likely that we are talking about delirium or dementia.

Diagnostic nuances

During the examination, pay attention to:

trembling of the whole body;
tachycardia (rapid heartbeat);
lability (jumps) of blood pressure;
tachypnea (rapid breathing).

In addition to differential diagnosis, they also use instrumental study and constantly monitor:

temperature;
breath;
pulse.

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Symptoms of inflammation sciatic nerve can't be confused with anything. Spicy and burning pain interfere to the usual way life, so it is important to start anti-inflammatory treatment as soon as possible. How right is that

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Treatment of alcoholic delirium

The process itself (including resuscitation measures) is best carried out in a specially equipped intensive care unit. emergency therapy at psychiatric hospitals.

Urgent Care

First aid in this case is aimed at:

Decreased ICP due to a high likelihood of cerebral edema.
Elimination of excitability.
Elimination of insomnia. The onset of sleep indicates the imminent end of delirium tremens.

Diazepam, Relanium, Seduxen (any one) - 20-40 mg into a vein or intramuscularly.
Elenium 100-150 mg intramuscular.
Phenazepam - maximum 10 mg/day.

You can replace the drugs with a combination:

barbamil 0.6 g + diphenhydramine 50 mg intramuscularly.
diprazine 50 g + diphenhydramine 50 mg intramuscular.
seduxen 20-40 mg + 20% sodium hydroxybutyrate solution 30-40 ml.

But it’s better not to experiment with this on your own.

Other measures to provide medical care

To eliminate intoxication and maintain heart function, use:

0.06% corglycone solution 1 ml + glucose solution 20% 10 ml intravenously;
cordiamine 2 ml (can be replaced camphor solution 20% 2 ml) up to 4 times a day subcutaneously.
Hemodesis drip.

If the patient is not on late stage, then it is advisable (and only the doctor decides) to give 40-80 g of prednisolone intramuscularly or orally.

For recovery, vitamins are prescribed:

B1 and B6. 5% solution up to 4 times a day, 5 ml intramuscularly. or intravenously.
AT 12. 2-5 mcg intramuscularly
Nicotine solution 1% solution. In severe delirium, administer carefully due to the possibility of collapse.
5% ascorbic acid solution whoa.

With a strong increase in blood pressure and increasing hypertension, 10-12 ml of 10% sodium chloride solution is prescribed.

To prevent cerebral edema, use 15 solutions of Lasix.

Treatment usually lasts 5-8 days. Recovery is marked by deep and long sleep.

A simplified treatment plan might look like this:

Consequences of alcoholic delirium

The fever of alcoholics can be a trigger for manifestation various kinds diseases, but in most cases the following occur:

Pneumonia (appears in 30% of cases).
Alcoholic cardiomyopathy (in 27% of cases, 4% ends in death).
Violation of vitamin metabolism.
Failure in acid-base condition.
Pancreatitis.
Kidney failure.
Rhabdomyolysis.
Liver failure.
Failures in water-salt balance.

With prolonged heavy drinking, men and women may experience quite different consequences drinking alcohol, and delirium tremens is rightfully considered one of the most dangerous among them.

Translated from Latin, such a state is characterized as an attack of madness or insanity of a person.

Delirium tremens or acute psychosis is a disease that is accompanied by a violation of a person’s consciousness, as a result of which the latter can experience various visual or auditory types of hallucinations.

Also, these symptoms are often accompanied by a delirious state and increased agitation of the patient. According to statistics, 35% of alcoholics have suffered from delirium tremens at least once, so the question of treatment this state more than relevant.

Delirium tremens or so-called delirium tremens can develop in those people who suffer from alcohol addiction and drink alcohol regularly.

Typically, patients reach this state within a couple of years. At the same time, it is characteristic that such a disease will arise in a person not while drinking alcohol, but already during the period of withdrawal from long drinking bout. Those people who have diseases of the central nervous system or have previously suffered a brain injury are especially susceptible to delirium tremens.

According to doctors, if a patient has already experienced signs of alcoholic delirium once, this means that with subsequent drinking, the person’s condition may rapidly worsen and real psychosis may develop. Therefore, for some people it is enough to drink 100 grams of alcohol over a couple of days in order to “see a squirrel.”

Symptoms

Due to the severity of symptoms, understand that a person is developing mental problems, you can even do it at home. No matter how strange it may be, if alcoholic delirium occurs, the patient will stop drinking alcohol and will not feel a craving for it. This syndrome provokes a person’s aversion to alcoholic beverages. In the evening, a person may experience mood changes: from calmness the patient can move to fears and depression. Often patients are very excited, they talk all the time and cannot sit quietly.

Gradually, a person develops severe tremors in his arms and legs. This is the first clear sign that the patient needs to be urgently hospitalized in a hospital before he develops life-threatening symptoms. dangerous symptoms. A person may suffer from nightmares, after which he completely loses the ability to sleep and suffers from insomnia. Acute attack Delirium tremens begins in the patient with hallucinations. In this state, a person can observe deceptions of perception, illusions, be afraid of shadows emanating from objects, or see all kinds of monsters that he was afraid of in childhood.

Visual hallucinations in such psychosis can be very different. Patients often scream that they are surrounded by spiders, snakes, cockroaches and other animals. Sometimes a person sees himself surrounded by cobwebs or strong ropes from which he cannot get out. All this provokes strong emotional disruptions. Sometimes hallucinations take on terrifying images when a person sees terrible disfigured faces in front of him, the patient is being beaten with sticks, and chaos reigns all around. Pictures in this state can change very quickly, thereby causing more suffering to the person.

Another type of hallucination during delirium tremens is auditory disturbances. Thus, a person can hear rustling sounds, unpleasant creaking, hissing, screams and curses. Such sounds will be accompanied by a picture of visual hallucinations observed by the patient. Sometimes people with psychosis think that something terrible is happening next to them. Often a person believes that they want to steal his children, kill his wife or relatives. The patient will want to help, but will not do so because strong feeling fear for yourself. A person's facial expressions during delirium tremens will be active.

Displays of fear are often observed on the patient's face. Sometimes there are hallucinations when the patient shows that he is crushing an insect with his hands or defends himself by waving them. The person’s speech will consist mainly of shouts and meek phrases. In this state, the patient may develop disorientation, so he may get lost in a well-known place, not understand where he is and how to get home. According to recent observations, it was revealed that in the morning hallucinations weaken and the patient feels better, in the evening his condition worsens.

Highlight the following types alcoholic delirium:

Reduced psychosis. It is accompanied by unexpressed signs of delirium tremens.
Atypical psychosis accompanied by disorientation and minor visual hallucinations.
Severe psychosis can occur along with complications. This is a complex form of the disease, which is accompanied by severe hallucinations.

It is important to note that if treatment (anonymous or open in a hospital) is not started in time, the patient’s condition will gradually worsen, which can ultimately lead to the patient’s death.

There is also such a definition as Korsakov psychosis. A mental disorder called Korsakov's psychosis develops due to damage to the human central nervous system during delirium tremens.

Consequences of this disease very serious, since in this case the patient may experience complete amnesia, that is, the person will forget everything. He will not be able to even tell how his current day went.

Gradually, such patients may fall into euphoria or indifference.

As a result of this psychosis, a person loses his ability to work. He literally becomes disabled. Sometimes, after a couple of years, the patient’s memory returns, but the patient’s ability to work usually never returns to normal.

Alcoholic delirium: stages of development and duration

According to clinical observations and people's forums, delirium tremens usually develops during the hangover period, that is, 1-2 days after drinking alcohol.

Signs of delirium tremens will develop rapidly, so the patient’s condition will only get worse every day. In many ways, the course of alcoholic delirium depends on the stage of alcoholism in a person. Moreover, if this is a primary lesion of the central nervous system, then the person can get away with only minor auditory hallucinations and loss of disorientation.

If the patient experiences a relapse of alcoholism, then delirium delirium can be very severe and even lead to cerebral edema. The duration of delirium tremens is largely determined by its stage. The first stage of the disease continues for three days after completely stopping drinking alcohol. The second stage of the disease lasts up to four days, and the third can last for a week. With the development of severe disorders in the central nervous system, signs of “squirrel” can be observed in a person for even longer.

The following stages of delirium tremens are distinguished:

The first stage is accompanied by memory, sleep and neurological disruptions. It is easily controlled with timely initiation of therapy.
The second stage is characterized by delirium and psychosis. The person does not yet have pronounced hallucinations.
The third stage in medicine is called severe, since in this case the patient can experience serious neurological disorders and hallucinations. This is the so-called “classic” delirium tremens in its traditional manifestation.

Acute alcoholic psychosis: diagnosis and therapy

If signs of acute alcoholic psychosis develop, a person should be called as soon as possible emergency assistance until his condition worsened. This disease can be diagnosed by a neurologist or narcologist who will examine the patient, collect anamnesis and see the results of blood and urine tests. Moreover, even an ordinary therapist will be able to understand that alcoholism has developed acute alcoholic psychosis during the initial observation of a person.

When to seek medical help

You can try to treat acute alcoholic psychosis at home, but there are certain signs that require you to urgently call a doctor.

These symptoms are:

It should be immediately noted that even if the patient is treated at home, he should inform the supervising narcologist or at least a therapist that he is in a state of alcoholic delirium. This way he will keep the specialist informed, who will be able to help him if necessary.

Traditional home care for a person with delirium tremens includes the following:

The patient should be put to bed and covered with a warm blanket if he is chilly. In case of increased aggressiveness, a person should be tied with belts so that he does not cause harm to himself or those close to him. This condition should not be neglected, since when hallucinations appear, the patient may not control himself at all.
The patient should be regularly given fluids in the form of juices, water, tea or compote to avoid dehydration. It is also important to cool the human body. The easiest way to do this is in the shower.
For nervousness and aggression, the patient will need to take sedative medications. For this purpose, the drugs Diphenhydramine or Piracetam are best suited.

It is important to understand that shouting or trying to re-educate a person in such a state is simply pointless, because the patient simply will not accept the words of the interlocutor.

At elevated temperature you need to take antipyretic drugs. In the event that a person’s condition does not return to normal within 2-3 days, the patient is indicated urgent hospitalization, because the lack of therapy will lead to even greater damage to the central nervous system, the transition of the disease to chronic form and the development of complications.

Alcoholic squirrel: definition, treatment and prevention

The medical term “alcoholic delirium” or popularly, alcoholic delirium, requires a long and carefully selected course of treatment. In this case, therapy should be carried out by a specialist who has experience working with people addicted to alcohol.

To cleanse the patient's body of toxins, droppers with hemodesis are usually used, as well as glucose infusions.

Hemosorption is used less frequently. To relieve agitation and normalize the functioning of the nervous system, a person is prescribed antipsychotics, as well as sedatives(Diphenhydramine, Seducen).

To normalize the functioning of the heart and support it, cardio medications (Corgliton, Cordiamine, etc.) are prescribed. As complementary therapy means can be used to improve metabolism, vitamin preparations and medications that normalize the patient’s respiratory system.

Treatment of alcoholic squirrel should always be comprehensive. It is important to stop attacks of hallucinations in time and remove toxins from the human body. The consequences of alcoholic squirrel can be quite different.

This largely depends on the timeliness of the start of treatment, as well as general stage neglect of the disease. Thus, some patients after alcoholic delirium get off with a slight fright, while others may fall into a coma or completely lose their memory. The possibility of death cannot be ruled out either.

Due to the effect on the central nervous system and the influence of hallucinations, the patient may not control his actions and cause harm to himself. Sometimes this leads to suicide. The only measure to prevent alcoholic delirium is to avoid drinking strong alcoholic drinks. In this case, the person does not risk meeting a “squirrel”.

In addition, there are following tips preventive measures that will help prevent this disease:

Do not drink alcohol every day, as this quickly accumulates toxins in the body that simply cannot be quickly eliminated from the body. That is why, in most cases, delirium tremens occurs after a long binge.
Drink alcohol in limited quantities.
Don't drink several at a time different types alcohol.
Use plenty of snacks.
When the first signs of delirium tremens appear, immediately consult a doctor before the patient’s condition worsens.

Delirium tremens is an acute mental disorder caused by long-term use alcohol. Characterized by severe disorder consciousness, delirium, visual and auditory hallucinations, loss of spatial orientation, aggression. This condition of the patient is observed 2–3 days after the end of the binge. There are no restrictions regarding age and gender.

Etiology

As for the etiology, there is only one reason - overuse alcohol. In most cases, delirium tremens (delirium tremens) appears on the third day after excessive alcohol consumption.

As a rule, delirium tremens develops when drinking alcohol for more than one week, with a dosage of more than 500 ml per day.

Signs

In this case, you can determine the onset of an attack of alcoholic delirium by the following signs:

the patient stops drinking alcohol, citing the fact that he is no longer interested in alcohol;
sudden change in mood;
trembling in the arms or legs;
visual or auditory hallucinations.

This condition of the patient can last from a couple of hours to several days. After this, an attack of delirium tremens occurs.

General symptoms

As shown medical practice, an attack of alcoholic delirium occurs closer to the night and has instant dynamics.

Symptoms of delirium tremens are:

hallucinations;
aggressive state of the patient;
delirium, partial memory loss;
tremor of fingers, tremors in knees;
abrupt, incoherent speech;
disorientation in time and space.

It is noteworthy that the patient can say his personal data - name, date of birth. But, at the same time, he forgets his relatives, place of residence and other facts.

At night, the symptoms of delirium tremens intensify. It is not uncommon for a person in such a state to attempt suicide or commit suicide itself.

In some cases, symptoms of delirium tremens go away. Such periods are called lucid intervals. At this time, a person can talk in detail about the picture of his visions, accurately convey his nightmares.

In addition to psychological disorders, the patient experiences the following physiological disorders:

elevated temperature – up to 40 degrees or more;
unstable arterial pressure;
dehydration of the body;
weakness - the patient practically does not get out of bed unless he is in a state of excitement;
chills;
the person comes out harsh, bad smell;
pallor of the skin.

This condition of the patient can last from several days to a week.

Forms of the disease

By international classification ICD-10 distinguishes only two forms of delirium tremens:

professional;
muscling.

The most dangerous is considered to be murmuring (in common parlance, muttering) delirium. With this condition, the patient can simply lie in bed, make strange sounds, and make movements that imitate wrapping and stroking. The danger of this condition is that there is a high probability of death.

Occupational alcoholic delirium is characterized by the patient’s condition during which he imitates his labor activity. At the same time, he not only makes movements characteristic of this, but also imitates sounds. This form of the disease is rarely fatal.

Diagnostics

Diagnosis of this condition consists of a personal examination of the patient. Laboratory and instrumental research methods are carried out only as the patient recovers. This is necessary in order to diagnose or exclude other background diseases caused by alcohol poisoning.

Treatment

Delirium tremens cannot be treated at home. In this condition, a person needs emergency hospitalization. Application of any unconventional methods Treatment for delirium tremens at home can be fatal.

When diagnosed with delirium tremens, a person is hospitalized in a drug treatment hospital or psychiatric ward. Only drug treatment is used to remove toxins from the body and introduce a person into deep dream. Prolonged sleep allows a person to return to normal much faster and regain clarity of consciousness.

After drug therapy the patient may feel lethargy, some weakness, and memory loss. In some cases, a person clearly remembers his hallucinations, but completely forgets real events.

Treatment of alcoholic delirium should be carried out only on an inpatient basis, under the supervision of a narcologist. In some cases, a psychologist or psychotherapist may be involved in treatment.

Health care

What to do if a person has delirium tremens, but there is no way to call an ambulance? The first thing you can do in this case is to provide first medical care before the doctors arrive:

put the person to bed, exclude access to objects with which he can harm himself or others (in as a last resort it can be tied to the bed);
apply to head cold compress;
give as much fluid as possible;
if the patient is in an excited, aggressive state, a sedative or sleeping pill should be given.

After this, you should immediately call an ambulance. There is nothing else you need to do until the doctors arrive.

Possible complications

As medical practice shows, delirium tremens almost always leaves consequences. Especially if you do nothing or treat at home. The most serious consequence in this case is death.

In other cases, the following consequences are possible:

disturbances in brain function;
spicy;
mental disorders;
ailments in the nervous system;
weakened the immune system;
deterioration of hearing and vision.

Such severe consequences due to the fact that there is a negative effect on the entire body, including the brain.

But the above consequences can be avoided if you do not abuse alcoholic beverages or give them up altogether. Death from delirium tremens accounts for 5 to 10% of the total number of cases. Most often, cerebral edema or cardiac arrest occurs.

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