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Delayed-onset delirium tremens – a diagnostic and management challenge

Published online by Cambridge University Press:  24 June 2014

Sahoo Saddichha ,
Narayana Manjunatha ,
Baxi Neeraj Prasad Sinha  and
Christoday R.J. Khess
Sahoo Saddichha*
Affiliation:
National Tobacco Control Program, WHO India, Kolkata, India
Narayana Manjunatha
Affiliation:
Centre for Addiction Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, India
Baxi Neeraj Prasad Sinha
Affiliation:
Clifton House, Teesdale South, Thornaby Place, Stockton-on-Tees, UK
Christoday R.J. Khess
Affiliation:
Centre for Addiction Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, India
*
Sahoo Saddichha, National Tobacco Control Program, WHO India, Kolkata, India. Tel: +919836530262; Fax: +916742572660; Email: saddichha@gmail.com
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Abstract

Background:

Delirium tremens (DT) is one of the most serious complications of alcohol withdrawal, affecting 5–10% of in-patients with a mortality rate up to 15%. DT, characterised by delirium and tremors, appears within 48–72 h of abstinence and persists for about 5–10 days.

Case presentation:

We report a case of DT in a young man with delayed onset on the 15th day after the cessation of alcohol use, despite an uncomplicated detoxification with benzodiazepine treatment.

Conclusion:

We hypothesise that the intake of country liquor in our patient, which contains higher percentages of alcohol, causes a prolonged imbalance of N-methyl-d-aspartic acid and glutamate receptor activity, leading to the picture of delayed-onset DT and that an atypical presentation at the time of admission and atypicality in early course are clinical pointers to the subsequent development of delayed-onset DT.

Keywords

delayed onsetdelirium tremens
Type
Case Report
Information
Acta Neuropsychiatrica , Volume 20 , Issue 3 , June 2008 , pp. 152 - 156
Copyright
Copyright © 2008 Blackwell Munksgaard

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