Jose, or Joe as friends call him, was supposed to bring adobo. The 52-year-old electrician never turns down invitations to weekend get-togethers hosted by fellow Filipinos living in a suburban community in the U.S.
A bachelor who has never been married, Joe lives alone in a small apartment. He likes to drink, sing karaoke and crack jokes, making him very popular among his Filipino friends.
But on this particular Saturday afternoon when his potluck assignment was the famous Philippine national dish, Joe failed to show up at his friend’s house. He also did not call or send a text message to his friend. Worried, the friend drove to Joe’s apartment and knocked on the door. There was no answer. He immediately called 911 and asked for an ambulance.
Paramedics found Joe on the floor, chest muscles twitching, hands trembling, skin clammy—clear signs of a seizure. When Joe tried to speak, his words were garbled. He was rushed to the nearest emergency room, where doctors diagnosed him as suffering from delirium tremens. Thanks to prompt intensive care and follow-up treatment, Joe eventually recovered.
A pack of beer a day for 27 years
Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes. It can occur when a person stops drinking alcohol after a period of heavy drinking, especially if he or she does not eat enough food. Delirium tremens is especially common in individuals who drink about 2 liters of hard alcohol (e.g. whisky, gin, vodka), or over 2 liters of wine, or more than 3 liters of beer every day for several months.
Joe had been drinking one pack of beer every day since he was 25—almost three decades. Not surprisingly, aside from alcohol abuse, Joe also suffers from diabetes mellitus, hypertension, high cholesterol and cardiovascular disease.
Joe was lucky. Despite appropriate treatment, between 5 and 15 percent of people who suffer delirium tremens die.[pq]Prior to the era of intensive care and advance drug treatments, up to 1 in 3 delirium tremens sufferers died.[/pq]
Death is usually due to respiratory failure and cardiac arrhythmia (irregular heartbeat).
At highest risk for death are those suffering from:
- High fever
- Fluid and electrolyte imbalance
- Alcoholic ketoacidosis
- Wernicke-Korsakoff syndrome (brain disorder due to vitamin B1 deficiency brought on by alcohol abuse).
Delirium tremens is a medical emergency requiring immediate intensive care in a hospital. Treatment focuses on reviving the patient, relieving symptoms and preventing complications. The healthcare team will closely monitor the following:
- Blood chemistry, such as electrolyte levels
- Body fluid levels
- Vital signs (temperature, pulse, rate of breathing, blood pressure)
Symptoms such as agitation, anxiety, tremors, seizures, and irregular heartbeat are treated with sedatives (e.g. diazepam or lorazepam) and anticonvulsants (e.g. phenobarbital). The patient may be sedated for a week or more until the alcohol withdrawal and delirium tremens episodes are finished. To treat his alcohol withdrawal, Joe takes lorazepam.
Other medical problems can occur with alcohol abuse. As such, the patient should be tested and, if needed, treated for:
- Alcoholic cardiomyopathy (heart failure)
- Alcoholic liver disease
- Alcoholic neuropathy (nerve damage)
- Wernicke-Korsakoff syndrome
Total, lifelong alcohol abstinence
Long-term preventive treatment should be started as soon as the patient recovers from the acute symptoms of delirium tremens. Total and lifelong avoidance of alcohol (abstinence) is recommended, as well as counseling and participation in support groups such as Alcoholics Anonymous.
– Innie Williams RN-BC,WCC, US Correspondent & Eric Michael Santos, Contributing Editor