Dong Wook Kim1, Hyun Kyung Kim2, Eun-Kee Bae3, So-Hee Park4, Kwang Ki Kim5. 1. Department of Neurology, Konkuk University School of Medicine, Seoul, Korea. Electronic address: drdongwkim@gmail.com. 2. Department of Neurology, National Medical Center, Seoul, Korea. Electronic address: crespy97@gmail.com. 3. Department of Neurology, Inha University Hospital, Incheon, Korea. Electronic address: alchemist021@gmail.com. 4. Department of Neurology, Konkuk University School of Medicine, Seoul, Korea. Electronic address: 20110383@kuh.ac.kr. 5. Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea. Electronic address: neukim@duih.org.
Abstract
BACKGROUND: Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures. METHODS: Patients who visited the emergency department with acute seizures were included in the study when alcohol withdrawal was the only or the strongest precipitating factor for seizures. All patients were carefully observed for at least 48 hours in the intensive care unit after the initial assessment to closely monitor vital signs and development of DT. Clinical and laboratory findings were analyzed for predicting the development of DT. RESULTS: Of the 97 patients (82 males; mean age, 48.6 ± 13.3 years) with alcohol withdrawal seizures, 34 (35.1%) developed DT. Low platelet count, high blood level of homocysteine, and low blood level of pyridoxine were associated with the subsequent development of DT. Low platelet count and high blood level of homocysteine were independent risk factors with high diagnostic sensitivity and specificity for the development of DT. CONCLUSIONS: The study indicated that some easily determined parameters are potential clinical predictors for the development of DT in patients with alcohol withdrawal seizures. These findings would be helpful in clinical identification and management patients at high risk for DT.
BACKGROUND:Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures. METHODS:Patients who visited the emergency department with acute seizures were included in the study when alcohol withdrawal was the only or the strongest precipitating factor for seizures. All patients were carefully observed for at least 48 hours in the intensive care unit after the initial assessment to closely monitor vital signs and development of DT. Clinical and laboratory findings were analyzed for predicting the development of DT. RESULTS: Of the 97 patients (82 males; mean age, 48.6 ± 13.3 years) with alcohol withdrawal seizures, 34 (35.1%) developed DT. Low platelet count, high blood level of homocysteine, and low blood level of pyridoxine were associated with the subsequent development of DT. Low platelet count and high blood level of homocysteine were independent risk factors with high diagnostic sensitivity and specificity for the development of DT. CONCLUSIONS: The study indicated that some easily determined parameters are potential clinical predictors for the development of DT in patients with alcohol withdrawal seizures. These findings would be helpful in clinical identification and management patients at high risk for DT.
Authors: Tunde Akinyeke; Sydney J Weber; April T Davenport; Erich J Baker; James B Daunais; Jacob Raber Journal: Behav Brain Res Date: 2016-11-08 Impact factor: 3.332
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Authors: Devavrat G Harshe; Harshal Thadasare; Sagar B Karia; Avinash De Sousa; Rashmin M Cholera; Sanjiv S Kale; Omkar S Mate; Nilesh Shah Journal: Indian J Psychol Med Date: 2017 Jul-Aug