Podcast 861: Alcohol Withdrawal and Delirium Tremens

<p dir="ltr"><strong>Contributor: Travis Barlock MD</strong></p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Alcohol binds the GABA receptor, which produces an inhibitory response, hence the “depressive” effects of ethanol beverages.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Over time, alcohol downregulates the GABA receptors, leading to unopposed glutamate activity. Given that glutamate is excitatory, this can lead to seizures.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Alcohol also suppresses REM sleep; in patients with chronically suppressed REM sleep, the brain starves for dream sleep and it spills over into the wakeful state, inducing a dream-like state when someone is awake.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">The awake dream-like state of delirium tremens (DT) differs from alcohol hallucinosis</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Alcohol hallucinosis presents with visual hallucinations in a wakeful state</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">DT presents with a generalized clouding of the sensorium and a dream-like state</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Treatment for DT is better achieved with phenobarbital due to predictable pharmacology</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Phenobarbital acts on GABA and NMDA receptors</p> </li> </ul> </ul> <p dir="ltr"><strong>References</strong></p> <p dir="ltr">1. Davies M. The role of GABAA receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci. 2003;28(4):263-274.</p> <p dir="ltr">2. Fujimoto J, Lou JJ, Pessegueiro AM. Use of Phenobarbital in Delirium Tremens. J Investig Med High Impact Case Reports. 2017;5(4):4-6. doi:10.1177/2324709617742166</p> <p dir="ltr">3. Walker, M. Chapter 13: iPads,