Repetitive Myocardial Infarctions Secondary to Delirium Tremens

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Abstract

Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.

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Most cited references 13

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Alcohol withdrawal delirium - diagnosis, course and treatment.

Barbora Mainerova, Jan Prasko, Klara Latalova … (2015)

Delirium tremens represents the most severe complication of alcohol withdrawal syndrome and, in its complications, significantly increases the morbidity and mortality of patients. Alcohol withdrawal delirium is characterized by features of alcohol withdrawal itself (tremor, sweating, hypertension, tachycardia etc.) together with general delirious symptoms such as clouded consciousness, disorientation, disturbed circadian rhythms, thought processe and sensory disturbances, all of them fluctuating in time. The treatment combines a supportive and symptomatic approach. Benzodiazepines in supramaximal doses are usually used as drugs of choice but in some countries such as the Czech Republic or Germany, clomethiazole is frequently used as well.

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Successful use of propofol in refractory delirium tremens.

Thomas R Coomes, Stephen W Smith (1997)

Alcohol withdrawal is a common problem encountered by emergency physicians, with delirium tremens (DT) as the extreme manifestation. DT is a true medical emergency. Although benzodiazepines are the mainstay of therapy, some patients require massive amounts to control their symptoms. We report the successful use of propofol for DT refractory to benzodiazepines in a 42-year-old alcoholic man. We briefly discuss alcohol withdrawal, as well as the pharmacokinetics and adverse affects of propofol. The use of propofol in treating DT refractory to benzodiazepines has previously not been reported.

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Refractory delirium tremens treated with propofol: a case series.

P Marik, C McCowan (2000)

Delirium tremens, the most serious manifestation of alcohol withdrawal, occurs in approximately 5% of hospitalized alcoholics and has a mortality rate approaching 15%. Patients with delirium tremens are usually treated in an intensive care unit in which benzodiazepines form the cornerstone of therapy. In this report, we describe four patients who proved refractory to high doses of benzodiazepines and were successfully treated with a propofol infusion.