Tremens

What is it?

The tremens (delirium tremens, metalkogolny psychosis) is the serious mental condition demanding emergency medical service.

At whom the tremens can develop?

Occurs only at the persons suffering from 2-3 stage of alcoholism when alcohol abuse duration more than 10-15 years. Much less often the tremens can arise at the people who are not suffering from an alcoholism, but after an episode of long alcohol intake in large numbers or the uses of substitutes of alcohol.

The tremens against the background of an abstinence syndrome, i.e. after the alcohol intake termination develops (after hard drinking).

The risk of development of a tremens is more at the people who had earlier craniocereberal injury, a serious illness of the central nervous system including inflammatory character, at the persons which already had earlier an episode of delirium tremens.

Clinic of a tremens. Symptoms and syndromes

The tremens develops for 2-3 days after the alcohol intake termination more often. The sleep disorder can become a harbinger of the main symptoms of a tremens. The dream is uneasy, is followed by nightmares, does not lead to rest. There can also be such symptoms as a headache, nausea, vomiting, disturbance of the speech, etc. However they are not specific and most often accompany any abstinence syndrome.

In clinic of a tremens it is possible to allocate 3 groups of syndromes:

- psychotic;

- vegetative;

- organic lesion of a brain.

Early symptoms of a tremens are the concern, feeling of inexplicable threat, fear. There are somatic symptoms: the increased perspiration, trembling of hands, a cardiopalmus, the increased arterial pressure. The sleep disorder gradually passes into sleeplessness. The patient is pursued by bright auditory and visual hallucinations. Most often at them there are fleas: cockroaches, bugs or animals. There can be also tactile hallucinations: feeling of crawling on a body of insects therefore such patients try to drive or crush them.

During a tremens of the patient can "hear" the voices something ordering it, abusing it, calling, teasing. The behavior of the person becomes inadequate. He is completely captured by hallucinations: "talks" to someone, shouts, tries to escape, "catches" on itself and clothes of "insects", etc. The boastful behavior is sometimes shown: in a condition of excitement the patient tells about "feats".

The condition of excitement can be replaced by the periods of imaginary wellbeing during which the behavior becomes quieter and adequate. However through a small period symptoms of a tremens renew.

From somatic symptoms in the developed clinic of delirium tremens it is possible to allocate: a hyperthermia (to 38-39 °C), high arterial hypertension (160-180/110 mm of mercury.), a tremor, strengthening of tendon jerks, the increased perspiration. Work of all internals is broken.

The typical tremens lasts 3-5 days. The first positive symptom of an exit from a condition of delirium tremens is improvement of a dream.

Tremens stages

1. The menacing delirium.

The general symptoms of cancellation of alcohol are characteristic. The patient can have all symptoms described earlier, however degree of manifestation insignificant. In the developed clinic disorientation in time and space can appear, however understanding of own personality remains. Body temperature does not exceed subfebrile figures. This stage is reversible and can come to an end randomly.

2. The made delirium.

All symptoms are brightly expressed. Auditory, visual and tactile hallucinations accrue. There are crazy experiences, is more often than unpleasant character. The somatic state worsens: there is short wind till 22-24 dykhaniye in a minute, AP (arterial pressure), pulse increases. At this stage spontaneous permission of a tremens is impossible. Without timely given help this stage quickly enough passes in 3.

3. Life-threatening delirium.

All mental symptoms along with explicit burdening of somatic remain. There is a block, the speech muffled, silent (mutter), reaction to external irritants decreases. The ABP sharply falls, filling of pulse weakens, an asthma becomes frequent. Gradually oppression of consciousness to a coma accrues. In this stage there can be irreversible changes of internals and systems, there comes the decompensation and, perhaps, death.

Tremens complications

• acute pancreatitis;
• pneumonia (development frequency about 30%);
• alcoholic myocardiopathy;
• liver failure;
• brain hypostasis;
• acute renal failure;
• disturbance of water and electrolytic balance and acid-base equilibrium;
• рабдомиолиз, etc.

Treatment of a tremens

Delirium tremens is the state needing not only in observation of the patient for the purpose of safety him and people around, but also demanding performing rather intensive medicinal care. In some cases even resuscitation actions are necessary. It is desirable to carry out treatment of a tremens on the basis of a psychoneurological hospital with obligatory involvement of the resuscitator and therapist.

Many drugs are offered, but at the moment there is no uniform point of view on an algorithm of treatment of a tremens.

In Europe the standard of treatment of a tremens is purpose of a klometiazol. In Russia and in the USA benzodiazepines were and remain drugs of the choice. It is possible to carry respiratory depression, cumulation of sedation to their shortcomings.

In most cases method of treatment of a tremens is the intravenous combination therapy benzodiazepines and a haloperidol (or Droperidolum).

In parallel with stopping of mental symptomatology for treatment of a tremens holding all intensive actions directed to elimination of somatic frustration is shown. At purpose of all drugs patients need to remember extent of influence them on a nervous system and possibilities of appointment of this group with an alcoholism.