Management of Delirium Tremens

A brief guide to the initial management of severe alcohol withdrawal or delirium tremens in the emergency department

Case

A 58 year old man is brought into the emergency department by his girlfriend because she thinks he had a seizure at home. He has a long history of alcoholism, and usually drinks about 1 litre of Newfoundland Screech rum every day. However, he had to stop drinking 3 days ago because of a brief stint in jail. He is tremulous, diaphoretic, confused, and complaining of visual hallucinations. His vital signs are a temperature of 37.8°C, heart rate 155, blood pressure 166/99, respiratory rate 22, and oxygen saturation 99% on room air…

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