ALCOHOL WITHDRAWAL DELIRIUM Leenard Michael A. Sajulga, RN
Alcohol withdrawal delirium• Delirium tremens• Alcoholic hallucinosis• An acute toxic state that follows a prolonged bout of steady drinking or sudden withdrawal from prolonged intake of alcohol
Alcohol withdrawal delirium• It may be precipitated by acute injury or infection• Symptoms can begin as early as 4 hours after a reduction of alcohol intake and usually peak at 24 to 48 hours, but may last up to 2 weeks.
NURSING ALERT Alcohol withdrawal delirium is aserious complication of inadequatewithdrawal management and is life- threatening.
PRIMARY ASSESSMENT ANDINTERVENTIONS
• Patient will present alert, unless experiencing a seizure• If the patient is having a seizure, ensure the airway.
• Assess for major symptoms—may occur independently or in combination. – Tremors – Seizures – Hallucinations (usually tactile)• Obtain drinking history, including the severity of past withdrawal episodes and any recent drug intake.
• Be aware that people tend to underestimate drinking habits.• Assess complaints of nausea and vomiting, malaise, weakness, anxiety, or fear.• Perform thorough examination for signs of autonomic hyperreactivity
– tachycardia, diaphoresis, elevated temperature, dilated but reactive pupils• Signs of coexisting illnesses or injuries – head injury, pneumonia, metabolic disturbances• Observe behavior for talkativeness, restlessness, agitation, or preoccupation.
• Protect the patient from injury. – The hallucinations may be visual, tactile, or auditory and are frequently frightening.• Take a breath analyzer reading—indicates where patient is in the withdrawal process.• Using a nonalcoholic skin preparation, draw blood for measurement of ethanol concentration, toxicologic screen for other drugs of abuse
• Pharmacologic interventions: – Diazepam (Valium) or chlordiazepoxide (Librium) for sedation. Sedate the patient with sufficient dosage of medication to produce adequate relaxation and to reduce agitation, prevent exhaustion, and promote sleep. – Diazepam (Valium) or phenytoin (Dilantin) for seizure control.• Monitor vital signs every 30 minutes.
• Place the patient in a private room for close observation.• Maintain electrolyte balance and hydration through oral or I.V. route—fluid losses may be extreme because of profuse perspiration, vomiting, and agitation.• Assess respiratory, hepatic, and cardiovascular status of patient—pneumonia, liver disease, and cardiac failure are complications.
• Observe for hypoglycemia, and treat appropriately. Hypoglycemia may accompany alcoholic withdrawal because alcohol depletes liver glycogen stores and impairs gluconeogenesis; many patients also suffer from malnutrition. – Administer thiamine followed by parenteral dextrose if liver glycogen is depleted. – Give orange juice, Gatorade, or other carbohydrates to stabilize blood sugar and to counteract tremulousness.