No abstract available.
Alcohol Withdrawal Delirium* ; Delirium*

Injection-related necrosis is a common pattern in the arterial injuries. But the acute embolization that led to extremity necrosis is very rare. Here we described a case of 43-year male patient with arm necrosis due to intra-arterial drug injection. The patient has addicted drug for 24 years and has injected opium for 18 years with dose of 2 ml self-prepared opium solution, 3-4 times daily. On April 2000, after second injection of a day, the patient felt burn and pain in his left hand. Then watery purples and necrotic papules appeared on the skin of left arm. He was treated by antibiotics, analgesics, and vasodilators, but the condition was not improved. The patients had to be amputated his left arm after 3 days of admission.
Substance Withdrawal Syndrome ; Alcohol Withdrawal Delirium ; diagnosis

BACKGROUD: It is generally acknowledged that a close relationship exists between chronic alcohol abuse and the occurrence of alcohol withdrawal seizure(AWS). About one third of AWS patients have been reported to be followed by delirium tremens (DT). OBJECTIVES: We assessed the factors that have influence on the development of DT in AWS patients. METHODS: We investigated clinical features and laboratory findings of 39 AWS patients who were admitted. The following factors were analyzed ; duration of alcohol intake, interval from last drinking to onset of AWS, interval from AWS to treatment, number of seizure, fever, laboratory findings (Mg, K, Na, Ca, P, respiratory alkalosis). RESULT: Fourteen patients developed DT(35.8%). There was fever in 36% of AWS patients with DT(5/14) and in 8% of AWS patients without DT(2/25). Number of seizure (p<.05) and interval from AWS to treatment(p<.01) showed statistically significant difference. But other factors were insignificant statistically. CONCLUSION: Our study suggests that number of seizure and interval from AWS to treatment seem to be significantly related to the development of DT in AWS patients.
Alcohol Withdrawal Delirium* ; Alcohol Withdrawal Seizures* ; Alcoholism ; Delirium* ; Drinking ; Fever ; Humans ; Risk Factors* ; Seizures ; Seizures, Febrile

Alcohol withdrawal syndrome (AWS) is a common condition occurring after intentional or unintentional abrupt cessation of alcohol in an alcohol-dependent individual. AWS represents a major problem in our society and alcohol withdrawal seizure is the major cause of seizures encountered by neurology residents in the emergency department. Patients with AWS present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Particularly, severe AWS can produce significant rates of the morbidity (complications) and mortality. When diagnosed and managed insufficiently, the morbidity and mortality rates increase. Nevertheless, patients with AWS may be neglected and are often marginalized and the teaching about AWS to neurology residents is usually minimal. Also, attending neurologists are often poorly informed on the topic. Although there is insufficient consensus about the optimal investigation and management, the purpose of this review is to serve as a summary of the appropriate identification and management of this important condition in a neurological setting.
Alcohol Withdrawal Delirium ; Alcohol Withdrawal Seizures* ; Consensus ; Dihydroergotamine ; Disease Management ; Emergency Service, Hospital ; Humans ; Mortality ; Neurology ; Seizures

PURPOSE: Alcohol related seizures (ARS) are common problems in community. We reviewed the clinical characteristics of ARS in chronic alcoholics and evaluated the predictors of delirium tremens and recurrence of seizures. METHODS: We thoroughly reviewed all medical records of patients with alcohol related seizures at admission and some outpatient records for follow-up data. For the patients who had been lost during follow-up, telephone interviews were performed. We described the clinical characteristics of ARS during admission and analyzed the correlation between initial findings of ARS. RESULTS: Forty eight patients with ARS were admitted and followup data were available in 33 patients by out-patient records or telephone interviews. Forty-four patients were male and the mean age was 47.4+/-10.4 years old. Nine out of 33 patients became completely abstinent after discharge. Ten out of 24 current drinkers developed recurrent seizures and 20 out of 48 patients developed delirium tremens (DT) during admission. The number of seizures and age ofpatients were significantly related with DT. Patients with much weekly- consumption of alcohol were prone to develop recurrent seizures. CONCLUSIONS:These results suggest that careful attention should be paid to the patients with older age and multiple seizures at each event about the development of DT and to the patients with much weekly-consumption of alcohol about the recurrence of seizures during follow-up.
Alcohol Withdrawal Delirium ; Alcoholics ; Follow-Up Studies ; Humans ; Interviews as Topic ; Male ; Medical Records ; Outpatients ; Recurrence ; Seizures

PURPOSE: We performed this study to identify the clinical characteristics of delirium tremens in Korea. METHODS: We reviewed the charts of patients suffering from delirium tremens who visited the Emergency Department of Keimyung University Hospital during the period of Jan. 2001 through Jun. 2002. RESULTS: All patients were mail, and the number was 28. The age distribution was 40~49, and the most common duration of drinking (15 cases) was between 11 and 20 years. The abstinence period before development of Delirium Tremens was, in most cases, less than 4 days, and the average period of symptoms of Delirium Tremens was less than 6 days. Various abnormal laboratory finding were noted: increased bilirubin level in 50%, prolonged pro-thrombin time in 14.3%, increased amylase level in 19.9% and electrolyte imbalance in 25%. CONCLUSION: During the study period, there was no mortalities. The author believes that sufficient vitamins and fluid supplement contributed to the results.
Age Distribution ; Alcohol Withdrawal Delirium* ; Amylases ; Bilirubin ; Delirium* ; Drinking ; Emergency Service, Hospital ; Humans ; Korea ; Mortality ; Postal Service ; Seizures ; Vitamins

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.
Alcohol Withdrawal Delirium* ; Alcoholism ; Bilirubin ; Delirium ; gamma-Glutamyltransferase ; Hematocrit ; Humans ; Logistic Models ; Mortality ; Platelet Count ; Potassium ; Retrospective Studies ; Risk Factors

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.
Alcohol Withdrawal Delirium* ; Alcoholism ; Bilirubin ; Delirium ; gamma-Glutamyltransferase ; Hematocrit ; Humans ; Logistic Models ; Mortality ; Platelet Count ; Potassium ; Retrospective Studies ; Risk Factors

Delirium tremens is a severe state of alcohol-related withdrawal syndrome, which is precipitated in the chronic alcoholic who are suddenly deprived of alcohol because of traumatic injury or other diseases. About 5 % of alcoholics show evidence of severe withdrawal symptoms. Symptoms begin within 1 to 3 days after stopping ethanol intake. These include a state of confusion sometimes accompanied by visual, tactile, or auditory hallucinations. The diagnosis is made when the course progresses beyond the usual symptoms of withdrawal to include confusion, severe agitation, and generalized seizures. The likelihood of developing severe withdrawal symptoms increases with concomitant infections or medical problems, a prior history of withdrawal seizures of DTs, and higher quantity and frequency of drinking. Most periods of severe withdrawal begin and end abruptly, rarely lasting longer than 3 to 5 days. The mortality risk for DTs is quite low but increases with preexisting medical illnesses or organ system failure. We experienced a case of DTs associated with fracture of mandible. The patient was a 36-years-old male who was admitted to our hospital via emergency room after suffering from a traffic accident. He developed DTs 3 days after admission and eventually expired. The report of a case and review of literatures are as follows.
Accidents, Traffic ; Alcohol Withdrawal Delirium* ; Alcoholics ; Delirium* ; Diagnosis ; Dihydroergotamine ; Drinking ; Emergency Service, Hospital ; Ethanol ; Hallucinations ; Humans ; Male ; Mandible* ; Mortality ; Seizures ; Substance Withdrawal Syndrome

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