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Alcohol withdrawal delirium

MedGen UID:
1398
•Concept ID:
C0001957
•
Disease or Syndrome
Synonyms: Alcohol Withdrawal Delirium; Alcohol Withdrawal Induced Delirium Tremens; Alcohol Withdrawal-Induced Delirium Tremens; Delirium Tremens; Delirium Tremens, Alcohol Withdrawal Induced; Delirium, Alcohol Withdrawal
SNOMED CT: Alcohol withdrawal delirium (8635005); Delirium tremens (8635005); DTs - delirium tremens (8635005)
 
Monarch Initiative: MONDO:0006642

Definition

An acute organic mental disorder induced by cessation or reduction in chronic alcohol consumption. Clinical characteristics include confusion; delusions; vivid hallucinations; tremor; agitation; insomnia; and signs of autonomic hyperactivity (e.g., elevated blood pressure and heart rate, dilated pupils, and diaphoresis). This condition may occasionally be fatal. It was formerly called delirium tremens. (From Adams et al., Principles of Neurology, 6th ed, p1175) [from MONDO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVAlcohol withdrawal delirium

Professional guidelines

PubMed

Current evidence and clinical utility of phenobarbital for alcohol withdrawal syndrome.
Nishimura Y, Choi H, Colgan B, Kistler H, Mercado F
Eur J Intern Med 2023 Jun;112:52-61. Epub 2023 Mar 21 doi: 10.1016/j.ejim.2023.03.006. PMID: 36935249
Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients.
Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T
Psychosomatics 2019 Sep-Oct;60(5):458-467. Epub 2019 Feb 14 doi: 10.1016/j.psym.2019.02.002. PMID: 30876654
Alcohol withdrawal delirium - diagnosis, course and treatment.
Mainerova B, Prasko J, Latalova K, Axmann K, Cerna M, Horacek R, Bradacova R
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015 Mar;159(1):44-52. Epub 2013 Dec 11 doi: 10.5507/bp.2013.089. PMID: 24399242

Recent clinical studies

Etiology

Treatment of Alcohol Withdrawal Syndrome: Phenobarbital vs CIWA-Ar Protocol.
Tidwell WP, Thomas TL, Pouliot JD, Canonico AE, Webber AJ
Am J Crit Care 2018 Nov;27(6):454-460. doi: 10.4037/ajcc2018745. PMID: 30385536
Alcohol withdrawal syndrome: diagnostic and therapeutic methods.
Attilia F, Perciballi R, Rotondo C, Capriglione I, Iannuzzi S, Attilia ML, Coriale G, Vitali M, Cereatti F, Fiore M, Ceccanti M; Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip
Riv Psichiatr 2018 May-Jun;53(3):118-122. doi: 10.1708/2925.29413. PMID: 29912213
ACG Clinical Guideline: Alcoholic Liver Disease.
Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH
Am J Gastroenterol 2018 Feb;113(2):175-194. Epub 2018 Jan 16 doi: 10.1038/ajg.2017.469. PMID: 29336434Free PMC Article
Outpatient management of alcohol withdrawal syndrome.
Muncie HL Jr, Yasinian Y, Oge' L
Am Fam Physician 2013 Nov 1;88(9):589-95. PMID: 24364635
Alcohol-use disorders.
Schuckit MA
Lancet 2009 Feb 7;373(9662):492-501. Epub 2009 Jan 23 doi: 10.1016/S0140-6736(09)60009-X. PMID: 19168210

Diagnosis

Alcohol withdrawal syndrome: diagnostic and therapeutic methods.
Attilia F, Perciballi R, Rotondo C, Capriglione I, Iannuzzi S, Attilia ML, Coriale G, Vitali M, Cereatti F, Fiore M, Ceccanti M; Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip
Riv Psichiatr 2018 May-Jun;53(3):118-122. doi: 10.1708/2925.29413. PMID: 29912213
ACG Clinical Guideline: Alcoholic Liver Disease.
Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH
Am J Gastroenterol 2018 Feb;113(2):175-194. Epub 2018 Jan 16 doi: 10.1038/ajg.2017.469. PMID: 29336434Free PMC Article
Alcohol withdrawal syndrome: mechanisms, manifestations, and management.
Jesse S, Bråthen G, Ferrara M, Keindl M, Ben-Menachem E, Tanasescu R, Brodtkorb E, Hillbom M, Leone MA, Ludolph AC
Acta Neurol Scand 2017 Jan;135(1):4-16. Epub 2016 Sep 1 doi: 10.1111/ane.12671. PMID: 27586815Free PMC Article
Identification and management of alcohol withdrawal syndrome.
Mirijello A, D'Angelo C, Ferrulli A, Vassallo G, Antonelli M, Caputo F, Leggio L, Gasbarrini A, Addolorato G
Drugs 2015 Mar;75(4):353-65. doi: 10.1007/s40265-015-0358-1. PMID: 25666543Free PMC Article
Recognition and management of withdrawal delirium (delirium tremens).
Schuckit MA
N Engl J Med 2014 Nov 27;371(22):2109-13. doi: 10.1056/NEJMra1407298. PMID: 25427113

Therapy

Alcohol withdrawal syndrome: diagnostic and therapeutic methods.
Attilia F, Perciballi R, Rotondo C, Capriglione I, Iannuzzi S, Attilia ML, Coriale G, Vitali M, Cereatti F, Fiore M, Ceccanti M; Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip
Riv Psichiatr 2018 May-Jun;53(3):118-122. doi: 10.1708/2925.29413. PMID: 29912213
Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes-Beyond Benzodiazepines.
Maldonado JR
Crit Care Clin 2017 Jul;33(3):559-599. doi: 10.1016/j.ccc.2017.03.012. PMID: 28601135
Identification and management of alcohol withdrawal syndrome.
Mirijello A, D'Angelo C, Ferrulli A, Vassallo G, Antonelli M, Caputo F, Leggio L, Gasbarrini A, Addolorato G
Drugs 2015 Mar;75(4):353-65. doi: 10.1007/s40265-015-0358-1. PMID: 25666543Free PMC Article
Recognition and management of withdrawal delirium (delirium tremens).
Schuckit MA
N Engl J Med 2014 Nov 27;371(22):2109-13. doi: 10.1056/NEJMra1407298. PMID: 25427113
Outpatient management of alcohol withdrawal syndrome.
Muncie HL Jr, Yasinian Y, Oge' L
Am Fam Physician 2013 Nov 1;88(9):589-95. PMID: 24364635

Prognosis

Alcohol-induced thrombocytopenia: Current review.
Silczuk A, Habrat B
Alcohol 2020 Aug;86:9-16. Epub 2020 Apr 21 doi: 10.1016/j.alcohol.2020.02.166. PMID: 32330589
ACG Clinical Guideline: Alcoholic Liver Disease.
Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH
Am J Gastroenterol 2018 Feb;113(2):175-194. Epub 2018 Jan 16 doi: 10.1038/ajg.2017.469. PMID: 29336434Free PMC Article
Alcohol withdrawal delirium - diagnosis, course and treatment.
Mainerova B, Prasko J, Latalova K, Axmann K, Cerna M, Horacek R, Bradacova R
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015 Mar;159(1):44-52. Epub 2013 Dec 11 doi: 10.5507/bp.2013.089. PMID: 24399242
The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome.
Maldonado JR, Sher Y, Ashouri JF, Hills-Evans K, Swendsen H, Lolak S, Miller AC
Alcohol 2014 Jun;48(4):375-90. Epub 2014 Feb 19 doi: 10.1016/j.alcohol.2014.01.004. PMID: 24657098
Alcohol withdrawal syndrome.
Carlson RW, Kumar NN, Wong-Mckinstry E, Ayyagari S, Puri N, Jackson FK, Shashikumar S
Crit Care Clin 2012 Oct;28(4):549-85. doi: 10.1016/j.ccc.2012.07.004. PMID: 22998991

Clinical prediction guides

Comparative efficacy and safety of pharmacotherapies for alcohol withdrawal: a systematic review and network meta-analysis.
Bahji A, Bach P, Danilewitz M, Crockford D, El-Guebaly N, Devoe DJ, Saitz R
Addiction 2022 Oct;117(10):2591-2601. Epub 2022 Mar 15 doi: 10.1111/add.15853. PMID: 35194860Free PMC Article
Alcohol-induced thrombocytopenia: Current review.
Silczuk A, Habrat B
Alcohol 2020 Aug;86:9-16. Epub 2020 Apr 21 doi: 10.1016/j.alcohol.2020.02.166. PMID: 32330589
The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome.
Maldonado JR, Sher Y, Ashouri JF, Hills-Evans K, Swendsen H, Lolak S, Miller AC
Alcohol 2014 Jun;48(4):375-90. Epub 2014 Feb 19 doi: 10.1016/j.alcohol.2014.01.004. PMID: 24657098
Alcohol withdrawal.
Manasco A, Chang S, Larriviere J, Hamm LL, Glass M
South Med J 2012 Nov;105(11):607-12. doi: 10.1097/SMJ.0b013e31826efb2d. PMID: 23128805
Agrypnia excitata.
Lugaresi E, Provini F, Cortelli P
Sleep Med 2011 Dec;12 Suppl 2:S3-10. doi: 10.1016/j.sleep.2011.10.004. PMID: 22136896

Recent systematic reviews

Current evidence and clinical utility of phenobarbital for alcohol withdrawal syndrome.
Nishimura Y, Choi H, Colgan B, Kistler H, Mercado F
Eur J Intern Med 2023 Jun;112:52-61. Epub 2023 Mar 21 doi: 10.1016/j.ejim.2023.03.006. PMID: 36935249
Comparative efficacy and safety of pharmacotherapies for alcohol withdrawal: a systematic review and network meta-analysis.
Bahji A, Bach P, Danilewitz M, Crockford D, El-Guebaly N, Devoe DJ, Saitz R
Addiction 2022 Oct;117(10):2591-2601. Epub 2022 Mar 15 doi: 10.1111/add.15853. PMID: 35194860Free PMC Article
Predictors of severe alcohol withdrawal syndrome: a systematic review and meta-analysis.
Goodson CM, Clark BJ, Douglas IS
Alcohol Clin Exp Res 2014 Oct;38(10):2664-77. doi: 10.1111/acer.12529. PMID: 25346507
The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome.
Maldonado JR, Sher Y, Ashouri JF, Hills-Evans K, Swendsen H, Lolak S, Miller AC
Alcohol 2014 Jun;48(4):375-90. Epub 2014 Feb 19 doi: 10.1016/j.alcohol.2014.01.004. PMID: 24657098
Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentary.
Awissi DK, Lebrun G, Coursin DB, Riker RR, Skrobik Y
Intensive Care Med 2013 Jan;39(1):16-30. Epub 2012 Nov 27 doi: 10.1007/s00134-012-2758-y. PMID: 23184039

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