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: Glufosinate-containing herbicides intoxication causes mild to severe complication, depending on patients' factors. However, it is not clearly known whether there are factors affecting glufosinate-containing herbicides intoxicated patients who develop complications. Thus, we sought to identify independent factors comparing the complicated group with the non-complicated group and to predict which patients will develop subsequent medical complication. METHODS: The medical records of patients with exposure to Glufosinate-containing herbicides at a tertiary academic university hospital in Korea from January 2012 to April 2015 were reviewed retrospectively. Demographic and clinical data of 75 patients were then analyzed by univariate and multivariate stepwise logistic regression analyses to identify potential predictors of significant complications following acute Glufosinate-containing herbicides poisoning for comparison of complicated patients with non-complicated patients. RESULTS: Of 75 patients, 44 (58.6%) had medical complications and 6 (8%) were dead. Neurologic complications (n=26, 35%) were the most common including seizure (n=18), delirium tremens (n=5), and amnesia (n=4). The results of univariate analysis showed that an advanced age (>60 years old), higher ingested amount of the herbicide (>100 mL), vomiting at arrival, medical history of hypertension, metabolic acidosis, and systemic inflammatory response score (SIRS)> or =2 were significant factors. However, the results of multivariate analysis showed that an advanced age (p<0.001) and higher ingested amount of herbicide (p<0.001) were independent factors associated with serious complications and require aggressive medical treatment. CONCLUSION: The results of this study showed that age>60 years, and amount ingested>100 mL were significant predictive factors for significant medical complications in patients with Glufosinate-containing herbicides poisoning.
Acidosis ; Alcohol Withdrawal Delirium ; Amnesia ; Herbicides* ; Humans ; Hypertension ; Korea ; Logistic Models ; Medical Records ; Multivariate Analysis ; Poisoning ; Retrospective Studies ; Seizures ; Vomiting

OBJECTIVE: This study was performed to analyze the clinical variables associated with occurrence of delirium tremens (DT) in inpatients with alcohol dependence initially admitted with diseases unrelated to alcohol. METHODS: This study included 132 inpatients seeking treatment for medical problem with acute alcohol withdrawal. The cases were divided into two groups : with DT group (n=44), without DT group (n=88). We compared the epidemiologic data, alcohol withdrawal symptoms and serum analysis data between two groups. We used the logistic regression to predict risk factors for DT. RESULTS: The DT group had more severe alcohol withdrawal symptoms, more amount of drinking alcohol, more number of drinking per month, higher blood urea nitrogen (BUN), creatinine, amylase, C-reactive protein and lower serum total protein than the without-DT group. According to the result of a logistic regression, occurrence of DT showed correlation with the following factors : sweating, hallucination, agitation, amount of alcohol consumption, number of drinking per month. CONCLUSION: Our study suggests development of DT was correlated with severe alcohol withdrawal symptoms, high BUN, creatinine and low total serum protein. Therefore, during assessment of alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent DT.
Alcohol Drinking ; Alcohol Withdrawal Delirium* ; Alcoholism* ; Amylases ; Blood Urea Nitrogen ; C-Reactive Protein ; Creatinine ; Dihydroergotamine ; Drinking ; Hallucinations ; Humans ; Inpatients ; Logistic Models ; Risk Factors ; Substance Withdrawal Syndrome* ; Sweat ; Sweating

We present a case of delirium tremens lasting for five weeks in an alcohol-dependent individual. The patient required high-dose benzodiazepines, which is atypical and rare. The clinical presentation and management of this patient is discussed.
Adult ; Alcohol Withdrawal Delirium ; diagnosis ; drug therapy ; psychology ; Anti-Anxiety Agents ; therapeutic use ; Diagnosis, Differential ; Diazepam ; therapeutic use ; Humans ; Liver Cirrhosis ; diagnosis ; Male ; Mental Status Schedule

OBJECTIVES: The aim of this study was to evaluate the risk factors of suicide attempt in patients with alcohol dependence. METHODS: A total of 68 patients admitted to the hospital for alcohol dependence were divided into two groups according to history of suicide attempt. In this study, sociodemographic variables, characteristics of alcohol drinking, and clinical scales were compared between the two groups. RESULTS: Regarding sociodemographic and clinical features, the alcoholic group with history of suicide attempt included more patients with no spouse, using medical aid in social security, and history of depressive disorder. Regarding characteristics of alcohol drinking, ages of first alcohol problems and first admission for alcohol problems were significantly younger in the attempter group. Patients in the attempter group had been drinking more and had higher frequency of delirium tremens and psychiatric admission. Regarding clinical scales, significantly higher scores for suicide ideation, depression, anxiety, and impulsiveness were observed in the attempter group. Among the scores for Temperament and character inventory, the score for persistence was significantly lower in the attempter group. After controlling for other compounding factors, depressive disorder [p=0.006, odds ratio (OR)=32.2] and suicide ideation (p=0.029, OR=1.2) were significant factors showing correlation with suicide attempt. CONCLUSION: Results of this study suggest that assessment and management of the depressive disorder and suicide ideation are necessary for suicide prevention in patients with alcohol dependence.
Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholics ; Alcoholism ; Anxiety ; Depression ; Depressive Disorder ; Drinking ; Humans ; Male ; Odds Ratio ; Risk Factors ; Social Security ; Spouses ; Suicide ; Temperament ; Weights and Measures

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

OBJECTIVES: The aim of this study was to analyze the clinical variables associated with the occurrence, duration, and severity of alcohol withdrawal delirium (AWD) in patients with alcohol dependence. METHODS: We conducted a retrospective case-control study in alcohol dependent inpatients admitted to the psychiatric department, between 2006 and 2012 (n=863). Multivariable logistic and linear regression models were used for analysis of risk factors associated with development of AWD and the duration of illness, respectively. And multivariable logistic regression models were applied for assessment of risk factors associated with seclusions or physical restraints, which reflect the severity of AWD. RESULTS: Significant predictors for the occurrence of AWD included higher body temperature, lower platelet count, lower serum potassium, higher drinking amount, history of AWD, and history of head trauma or structural brain lesion. Variables associated with prolongation of delirium included higher body temperature, higher drinking amount, and less use of benzodiazepine during the AWD episode. Significant predictors for severe AWD included higher systolic blood pressure, longer duration of harmful alcohol use, and higher drinking amount. CONCLUSION: Easily determinable parameters, such as vital signs and past history related to drinking are significantly associated with not only development of AWD, but also its severity and duration. Therefore, when initially assessing alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent occurrence of risky withdrawal delirium and behavioral problems.
Alcohol Withdrawal Delirium ; Benzodiazepines ; Blood Pressure ; Body Temperature ; Brain ; Case-Control Studies ; Craniocerebral Trauma ; Delirium ; Drinking ; Humans ; Inpatients ; Linear Models ; Logistic Models ; Platelet Count ; Potassium ; Restraint, Physical ; Retrospective Studies ; Risk Factors ; Vital Signs

Alcohol-related disorders are among the most costly health problems worldwide. Ingested alcohol is mainly metabolized by an oxidative pathway in the liver. Alcohol and its metabolic products (e.g., acetaldehyde and reactive oxygen species) have toxic effects on multiple organs, especially the nervous system. The diverse mechanisms of alcohol-related neurologic disorders include the direct toxic effects of alcohol, the alcohol withdrawal effect, nutritional deficiency secondary to alcoholism, and abnormalities of serum electrolytes and osmolality. We analyzed 156 cases of alcoholrelated neurologic disorders among admitted patients that had been referred in Korea during the previous 10 years. The duration of alcohol consumption ranged from 0.5 to 47 years (mean=17.8 years) and the mean amount of alcohol intake per day was 245.5 g. The 156 patients had the following diseases: Wernicke's encephalopathy (n=81, 51.9%), peripheral neuropathy (n=68, 43.6%), delirium tremens (n=59, 37.8%), Rum fit (n=31, 19.9%), pellagra encephalopathy (n=29, 18.6%), Korsakoff's psychosis (n=22, 14.2%), cerebellar atrophy (n=11, 7.0%), and alcoholic myopathy (n=6, 3.8%). We report on these cases and review the literature on alcohol-related neurologic disorders.
Acetaldehyde ; Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholic Neuropathy ; Alcoholics ; Alcoholism ; Atrophy ; Electrolytes ; Humans ; Korea ; Liver ; Malnutrition ; Marchiafava-Bignami Disease ; Muscular Diseases ; Nervous System ; Nervous System Diseases ; Osmolar Concentration ; Oxygen ; Pellagra ; Peripheral Nervous System Diseases ; Psychotic Disorders ; Wernicke Encephalopathy

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

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