Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T01:31:33.248Z Has data issue: false hasContentIssue false

A Case of Alcohol Withdrawal Requiring 1,600 mg of Lorazepam in 24 Hours

Published online by Cambridge University Press:  07 November 2014

Abstract

Alcohol withdrawal continues to present significant morbidity and mortality in hospitalized medical/surgical patients. The authors present a case of a patient with delirium tremens requiring up to 1,600 mg/day of lorazepam and discuss alternative treatments for alcohol withdrawal.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Foy, A, Kay, J. The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population. Drug Alcohol Rev. 1995;14:4954.Google Scholar
2.Yost, DA. Alcohol withdrawal syndrome. Am Fam Physician. 1996;54:657–664, 669.Google Scholar
3.Espir, ML, Rose, FC. Alcohol, seizures, and epilepsy. J R Soc Med. 1987;9:542543.CrossRefGoogle Scholar
4.Franklin, JE, Frances, RJ. Alcohol and other psychoactive substance use disorders. In: Hales, RE, Yudofsky, SC, eds. Essentials of Clinical Psychiatry Based on The American Psychiatric Press Textbook of Psychiatry. 3rd Ed. Washington DC: APPI; 2005:185232.Google Scholar
5.Mayo-Smith, MJ, Beecher, LH, Fischer, TL, et al.Management of alcohol withdrawal delirium. Arch Intern Med. 2004;164:14051412.CrossRefGoogle ScholarPubMed
6.Ballenger, JC. Benzodiazepines. In: Shatzberg, AF, Nemeroff, CB, eds. Essentials of Clinical Psychopharmacology. Washington, DC: APPI; 2001:7592.Google Scholar
7.Mayo-Smith, MF. Pharmacological management of alcohol withdrawal: A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on pharmacological management of alcohol withdrawal. JAMA. 1997;278:144151.Google Scholar
8.Holbrook, AM, Crowther, R, Lotter, A, Cheng, C, King, D. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. CMAJ. 1999;160:649655.Google Scholar
9.Hersh, D, Kranzler, HR, Meyer, RE. Persistent delirium following cessation of heavy alcohol consumption: diagnostic and treatment implications. Am J Psychiatry. 1997;154:846851.Google Scholar
10.Hayes, PC, Faestel, PM, Shimanoto, PL, Shimamoto, PL, Holland, C. Alcohol withdrawal requiring massive prolonged benzodiazepine infusion. Mil Med. 2007;172:556559.Google Scholar
11.Kunkel, EJS, Rodgers, C, DeMaria, PA, et al.Use of high dose benzodiazepines in alcohol and sedative withdrawal delirium. Gen Hosp Psychiatry. 1997;19:286293.Google Scholar
12.Lineaweaver, WC, Anderson, K, Hing, DN. Massive doses of midazolam infusion for delirium tremens without respiratory depression. Crit Care Med. 1988;16:294295.Google Scholar
13.Nolop, KBNatow, A. Unprecedented sedative requirements during delirium tremens. Crit Care Med. 1985;13:246247.CrossRefGoogle ScholarPubMed
14.Wolf, KM, Shaughnessy, AF, Middleton, DB. Prolonged delirium tremens requiring massive doses of medication. J Am Board Fam Pract. 1993;6:502504.Google ScholarPubMed
15.Woo, E, Greenblatt, DJ. Massive benzodiazepine requirements during acute alcohol withdrawal. Am J Psychiatry. 1979;136:821823.Google Scholar
16.Hemmingsen, R, Kramp, P. Delirium tremens and related clinical states: psychopathology, cerebral pathophysiology and psychochemistry: a two-component hypothesis concerning etiology and pathogenesis. Acta Psychiatr Scand Suppl. 1988;354:94107.Google Scholar
17.Cagetti, E, Liang, J, Spigelman, I, Olsen, RW. Withdrawal from chronic intermittent ethanol treatment changes subunit composition, reduces synaptic function, and decreases behavioral responses to positive allosteric modulators of GABAa receptors. Mol Pharmacol. 2003;63:5364.CrossRefGoogle ScholarPubMed
18.Rogawski, MA. Update on the neurobiology of alcohol withdrawal seizures. Epilepsy Curr. 2005;5:225230.Google Scholar
19.Davis, KM, We-JY, . Role of glutamatergic and GABAergic systems in alcoholism. J Biomed Sci. 2001;8:719.CrossRefGoogle ScholarPubMed
20.Krupitsky, EM, Rudenko, AA, Burakov, AM, et al.Antiglutamatergic strategies for ethanol detoxification: comparison with placebo and diazepam. Alcohol Clin Exp Res. 2007;31:604611.CrossRefGoogle ScholarPubMed
21.Gold, JA, Rimal, B, Nolan, A, Nelson, LS. A strategy of escalating doses of benzodiazepines and Phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007;35:724730.Google Scholar
22.McCowan, C, Mark, P. Refractory delirium tremens treated with propofol: a case series. Crit Care Med. 2000;28:17811784.Google Scholar
23.Coomes, TR, Smith, SW. Successful use of propofol in refractory delirium tremens. Ann Emerg Med. 1997;30:825828.Google Scholar
24.Ninan, PT, Cole, JO, Yonders, KA. Nonbenzodiazepine anxiolytics. In: Shatzberg, AF, Nemeroff, CB, eds. Essentials of Clinical Psychopharmacology. Washington, DC: APPI; 2001:93102.Google Scholar
25.Metten, P, Crabbe, JC. Genetic determinants of severity of acute withdrawal from diazepam in mice: commonality with ethanol and pentobarbital. Pharmacol Biochem Behav. 1999;63:473479.Google Scholar
26.Van Munster, BC, Korevaar, JC, de Rooij, SE, Levi, M, Zwinderman, AH. Genetic polymorphisms related to delirium tremens: a systematic review. Alcohol Clin Exp Res. 2007;31:177184.Google Scholar
27.Preuss, UW, Zill, P, Koller, G. Ionotropic glutamate receptor gene GRIK3 SER310ALA functional polymorphism is related to delirium tremens in alcoholics. Pharmacogenomics J. 2006;6:3441.Google Scholar
28.Carta, M, Ariwodola, OJ, Weiner, JL, Valenzuela, CF. Alcohol potently inhibits the kainite receptor-dependent excitatory drive of hippocampal interneurons. Proc Natl Acad Sci USA. 2003;100:68136818.Google Scholar
29.Lum, E, Gorman, SK, Slavik, RS. Valproic acid management of acute alcohol withdrawal. Ann Pharmacother. 2006;40:441448.Google Scholar
30.Polycarpou, A, Papanikalaou, P, Ioannidis, J, Contopoulos-loannidis DG. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2005;3:CD005064.Google Scholar