Delerium, alcohol intoxication and withdrawal.

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Which of the following is the best definition of delerium?

An acute cerebral deterioration.

An acute generalised brain disorder.

An acute brief cerebral event.

A confusional cerebral state.

The origin of the word Delerium:

Mid 16Century ---from Latin delirare "deviate" , to be deranged.

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Which of the following is the primary receptor that alcohol affects?

GABAA.

ABBAD.

Seotonin.

Nicotinic.

GABAA is the primary inhibitory receptor in the brain. Alcohol increases the sensitivity of this receptor.

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Which of the following is NOT a principle of treating delerium in older patients.

Look for and treat the underlying cause.

Use Benzodiazepines as your primary drug of choice.

Reassurance and empathy may be sufficient to calm the patient.

Often an oral antipsychotic like Olanzepine 10mg is sufficient.

The concern in using benzodiazepines in older patients is the real risk of respiratory depression.

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Which of the following best characterises alcohol withdrawal seizures?

Brief. Often multiple. Generalised. Usually occur 1 week after stopping drinking.

Brief. Generalised. Respond well to Keppra IV.

Brief. May be partial or generalised. Resistant to Benzodiazepines.

Brief. Generalised. Tonic clonic. Mainly occur in first 1 to 3 days after stopping drinking.

They are brief and generalised tonic clonic seizures. Many occur in the first 6hrs after stopping drinking with most occurring in the first 24hrs. Use Benzodiazepines. Phenytoin and Keppra have little role.

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George Clooney played "Doug Ross" a Paediatric Fellow working in the ED. He was drunk in the first episode of ER. Which of the following is INCORRECT about George Clooney?

His mother was a beauty queen and his father a TV anchorman.

He had "Bells palsy" at high school.

In 1988 he played a lead role in the film "Return of the Killer Tomatoes".

He is a long time Donald Trump supporter.

He is a Democrat not a Republican so he does not support Donald Trump.

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Which of the following is WRONG about alcoholic hallucinosis?

You have a degree of confusion.

It is less dangerous than Delerium Tremens.

You may have visual or auditory hallucinations.

It occurs earlier than delerium tremens after stopping alcohol.

Importantly you have a clear sensorium. Treatment is often oral or IM antipyschotics.

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What symptoms or signs would you expect to see in Delerium Tremens?

Clear sensorium but shakes, tachycardia and elevated temp.

High fever, shakes, hallucinations, hyporeflexia.

Altered mental state, agitation, tachycardia, sweating, tremor.

Altered mental state, bradycardia, hypertension, sweating.

These patients are sick and have a significant death rate. Temp may be low grade up to around 38 degrees.

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How severe is your withdrawal if you score 7 on the "Alcohol Withdrawal scale"?

Mild.

Moderate.

Severe.

Really severe.

The scale goes from 0 to 27. It scores Perspiration, Tremor, Anxiety, Axillary temp, Hallucinations, Orientation and Agitation.

Score <4 = mild.

Score 5-14 = moderate.

Score >15 = severe.

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What is a reasonable treatment regime to start for someone with Delerium Tremens?

Diazepam 10 to 20mg IV to a max of 80mg to get AWS <4.

Haloperidol 2.5 to 10mg to max of 20mg to get AWS <4.

Oral Olanzepine 10mg to a max of 40mg to get AWS <4.

Diazepam 10 to 20mg IM to a max of 40mg to get AWS <4.

Diazepam is the choice medication. Do not give it IM. In USA they often quote much higher initial maximums of Diazepam IV. Remember also to give Thiamine 300mg IV then 100mg tds as well as correcting electrolytes and treating dehydration.

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Whom of the following did NOT suffer from Delerium Tremens?

Graham Chapman (From Monty Python).

Elizabeth Taylor (Actress).

Vincent Van Gogh (Painter).

Carrie Fisher (Princess Leia in Star Wars).

Carrie Fisher did abuse a lot of drugs but apparently never suffered from Delerium Tremens. Graham Chapman suffered from Delerium Tremens during the making of "Monty Python and the Holy Grail".