Delirium tremens

Revision as of 17:59, 15 February 2016 by 3amrbadawy (talk | contribs)


  • Onset after last drink - 48 to 96hrs

Clinical Features

  • Delirium
    • Disconnected from the environment
  • Hyperdynamic vital signs
  • Febrile

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma


General Psychiatric



  • Goal = sleepy, but arousable w/ HR <110
  • Diazepam
    • Long duration of action, max effect within 5min
    • Start 10mg IV
      • Redose q5min after observing effect
      • Can double subsequent doses until achieve goal
  • Propofol
    • Consider intubation + propofol drip if benzo-nonresponsive
  • Thiamine 100mg

Special Situations

  • The propylene glycol diluent in lorazepam, phenobarbital and diazepam, may induce a hyperosmolar anion gap metabolic acidosis if given as a drip in high doses ≥ 48hrs.[1] Consider alternatives such as propofol or dexmedetomidine if patients need long term sedation for Delirum Tremens



See Also

External Links


  1. Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults*. Critical Care Medicine. 2004;32(8):1709–1714. doi:10.1097/01.CCM.0000134831.40466.39.