The other day, I saw my first true case of delerium tremens. I have seen lots of people withdrawing from alcohol, even alcohol withdrawal siezures, but this was the first true case of delerium tremems of my career.
He was native american (who do not genetically metabolize alchol well, but I think that’s irrelavent) who had been locked out of his house by his roommate all day & night. He told me he drinks daily, but I didn’t trust the amount he told me. In medical school, we were taught to always multiply the amount the patient says by two. (Keep that in mind when your doc asks you how much you smoke or drink. 😉 ) He had gone at least 24 hours without a drink, but possibly more. He looked like a wreck with soiled undies & covered with layers of dirt and mud.
While he was in the department, he had “the shakes” continuously. I tried some ativan to calm him down, but it didn’t make a bit of difference. I tried more ativan to no avail. His hallucinations, originally entertaining for the staff, became bizarre & strange and he stopped interacting with us all together, responding only to the voices and images his mind had created. They were all around his bed, you could almost see them clearly by the way he interacted with them. It was very unsettling. Despite fluids, he remained tachycardic, and I finally made the decision to intubate him and squash the building neurotransmitter overload going on in his brain with my favorite sedative, propofol, aka “milk of amnesia”.