J Korean Neuropsychiatr Assoc.  2012 Jul;51(4):164-169.

Clinical Factors Correlated to Delirium Tremens during Acute Alcohol Withdrawal of Inpatients with Alcohol Dependence

Affiliations
  • 1The Korean Alcohol Research Foundation, KARF Hospital, Goyang, Korea. lee.bunhee@gmail.com

Abstract


OBJECTIVES
The aim of this study was to explore clinical factors or high-risk factors associated with occurrence of delirium tremens (DT) during acute alcohol withdrawal in inpatients with alcohol dependence.
METHODS
This study included 164 inpatients seeking treatment for acute alcohol withdrawal in the detoxification unit. All subjects were evaluated prospectively for known risk factors for DT and their occurrence of DT. Correlations were determined between risk factors obtained at admission and development of DT.
RESULTS
Among all subjects, 42 patients (25.6%) suffered from delirium tremens within seven days after admission. DT patients had more severe alcohol withdrawal symptoms, the presence of past DT, and higher levels of aspartate aminotransferas, alanine aminotransferase, gamma-glutamyl-transpeptidase, and homocysteine, compared with patients who did not suffer DTs. According to results of a multiple regression, occurrence of DT showed correlation with the following factors at admission: tremor, a past history of DT, higher homocysteine level, and nausea and vomiting.
CONCLUSION
Development of DT showed correlation with symptoms of severe alcohol withdrawal, past history of DT, and higher homocysteine level. Among these, a severity of alcohol withdrawal symptoms and a history of DT are factors that can be easily evaluated on the day of admission in order to predict the potential for occurrence of DT.

Keyword

Alcohol dependence; Delirium tremens; Clinical factor

MeSH Terms

Alanine Transaminase
Alcohol Withdrawal Delirium
Alcoholism
Aspartic Acid
Delirium
Homocysteine
Humans
Inpatients
Nausea
Prospective Studies
Risk Factors
Substance Withdrawal Syndrome
Tremor
Alanine Transaminase
Aspartic Acid
Homocysteine

Reference

1. Griffin RE, Gross GA, Teitelbaum HS. Delirium tremens: a review. J Am Osteopath Assoc. 1993. 93:924929–932. 935
2. Schuckit MA, Tipp JE, Reich T, Hesselbrock VM, Bucholz KK. The histories of withdrawal convulsions and delirium tremens in 1648 alcohol dependent subjects. Addiction. 1995. 90:1335–1347.
3. Ferguson JA, Suelzer CJ, Eckert GJ, Zhou XH, Dittus RS. Risk factors for delirium tremens development. J Gen Intern Med. 1996. 11:410–414.
4. Wojnar M, Bizoń Z, Wasilewski D. The role of somatic disorders and physical injury in the development and course of alcohol withdrawal delirium. Alcohol Clin Exp Res. 1999. 23:209–213.
5. Palmstierna T. A model for predicting alcohol withdrawal delirium. Psychiatr Serv. 2001. 52:820–823.
6. Monte R, Rabunñal R, Casariego E, Bal M, Pértega S. Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting. Eur J Intern Med. 2009. 20:690–694.
7. Lutz UC. Alterations in homocysteine metabolism among alcohol dependent patients--clinical, pathobiochemical and genetic aspects. Curr Drug Abuse Rev. 2008. 1:47–55.
8. Kim MJ, Kim SG, Kim HJ, Kim HC, Park JH, Park KS, et al. A study of the reliability and validity of the Korean version of the Penn Alcohol Craving Scale for alcohol-dependent patients. Psychiatry Investig. 2008. 5:175–178.
9. Sellers EM, Sullivan JT, Somer G, Sykora K. Characterization of DSM-III-R criteria for uncomplicated alcohol withdrawal provides an empirical basis for DSM-IV. Arch Gen Psychiatry. 1991. 48:442–447.
10. Fiellin DA, O'Connor PG, Holmboe ES, Horwitz RI. Risk for delirium tremens in patients with alcohol withdrawal syndrome. Subst Abus. 2002. 23:83–94.
11. Lee CH, Lee E, Park SH, Jung SY, Park SJ, Soek JH, et al. Prediction of the development of alcohol withdrawal delirium. J Korean Neuropsychiatr Assoc. 2004. 43:559–563.
12. Lee JH, Jang MK, Lee JY, Kim SM, Kim KH, Park JY, et al. Clinical predictors for delirium tremens in alcohol dependence. J Gastroenterol Hepatol. 2005. 20:1833–1837.
13. Rommelspacher H, Schmidt LG, Helmchen H. [Pathobiochemistry and pharmacotherapy of alcohol withdrawal delirium]. Nervenarzt. 1991. 62:649–657.
14. Lipton SA, Kim WK, Choi YB, Kumar S, D'Emilia DM, Rayudu PV, et al. Neurotoxicity associated with dual actions of homocysteine at the N-methyl-D-aspartate receptor. Proc Natl Acad Sci U S A. 1997. 94:5923–5928.
15. Bleich S, Bayerlein K, Reulbach U, Hillemacher T, Bönsch D, Mugele B, et al. Homocysteine levels in patients classified according to Lesch's typology. Alcohol Alcohol. 2004. 39:493–498.
16. Wetterling T, Kanitz RD, Veltrup C, Driessen M. Clinical predictors of alcohol withdrawal delirium. Alcohol Clin Exp Res. 1994. 18:1100–1102.
17. Hersh D, Kranzler HR, Meyer RE. Persistent delirium following cessation of heavy alcohol consumption: diagnostic and treatment implications. Am J Psychiatry. 1997. 154:846–851.
18. Kraemer KL, Mayo-Smith MF, Calkins DR. Independent clinical correlates of severe alcohol withdrawal. Subst Abus. 2003. 24:197–209.
19. Wetterling T, Driessen M, Kanitz RD, Junghanns K. The severity of alcohol withdrawal is not age dependent. Alcohol Alcohol. 2001. 36:75–78.
Full Text Links
  • JKNA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr