Autonomic hyperactivity syndrome 6–72 h after cessation in dependence; delirium tremens is the severe form with confusion and hallucinations.
Clinical features
- • Tremor, sweating, anxiety (6–12 h)
- • Seizures (12–48 h)
- • Delirium tremens with visual hallucinations (48–72 h)
Investigations
- • CIWA-Ar scoring
- • FBC, LFT, clotting, U&E, magnesium, glucose
- • Consider CT head if focal signs or head injury
Management
- • Chlordiazepoxide symptom-triggered regimen (or lorazepam in liver failure)
- • Pabrinex IV high potency before any glucose
- • Correct magnesium and potassium
- • Delirium tremens: oral lorazepam, escalate to ICU if refractory
Complications
- • Wernicke's encephalopathy → Korsakoff
- • Status epilepticus
- • Aspiration
- • Arrhythmia
Clinical pearls
- • Give thiamine before carbohydrate load
- • Fixed-dose regimens over-sedate in liver failure — use symptom-triggered dosing
Related in WardRound
Educational — verify locally.
