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  Česky / Czech version Prakt. Lék., 2005, 85, No. 11, p. 618–621.
 
Delirium tremens - causal risk factors 
PILCH R. 

Psychiatrická léčebna Kroměříž, zastupující ředitel prim. MUDr. M. Koupil
 


Summary:

       In the study there are followed up certain risk factors in two categories of patients: 1. Patients in a statě of delirium upon withdrawal of alcohol 2. Patients weaning from alcohol without any delirium Objective: To determine important risk factors in the appearance and development of delirium tremens, that could then be utilized in clinical practice, námely in checking in of patients and distributing them to diffe-rent wards, as well as in the planning of further treatment and in diminishing the risk of developing com-plications of the statě of delirium. Methods: Out of all patients admitted in 2004 at the department for acute cases and for treating addictions at the Psychiatrie Hospital in Kroměříž there háve been selected two groups of male patients. The distribu-tion into two groups was determined by fitting under diagnosis F 10.3 or F 10.4 according to the Internati¬onal Classification of Diseases 10. In both groups there háve been followed up the following risk factors: 1. epileptic seizure at admission or in personál history, 2. hypertension or elevated blood pressure at admissi-on, 3. head injury, 4. other trauma before admission, 5. hypokaliaemia, 6. inereased ALT and/or AST, 7. liver cirrhosis, 8. diabetes mellitus, 9. gastric uleers or gastropathy, acute and/or in personál history, 10. panere-atopathy, 11. temperatures or infection, 12. manifestations of withdrawal syndrome under simultaneous ebriety at admission. Further, there has also been followed up the frequency of simultaneously present symptoms. There háve been searched for connections between the risk factors and the development or pre¬sence of delirium tremens. The study comprised a total of 87 patients, of whom 57 suffered delirium, and 30 with simple withdrawal syndrome only. Results: In the group of patients suffering delirium there háve oceurred to a statistically more significant degree hypokaliaemia - RR=3.8 (1.2-12.0), epilepsy - RR=2.75 (1.1-6.9), and the presence of four and more symptoms simultaneously - RR=2.6 (1.1-6.5). A minor finding was a higher mean age in the F 10.4 group - 4719.0 years as against 4318.4 in the F 10.3 group at p<0.05. The finding of elevated liver enzyme testes was of borderline statistical significance (p<0.10). Significantly more frequent was the finding of the following signs: injury of the head and extremities, temperatures and panereatopathy. On the other hand, in the group of patients with simple withdrawal syndrome without delirium there was to a statistically significant degree more frequently present the simultaneous finding of ebriety and abstinence symptoms – RR=6.6 (1.9–23.6). Conclusions: The important risk signs identified can relatively easily be detected on admission of the patient by clinical and laboratory investigations, or from his personal history. In thus identified risk groups of checked-in patients there can follow intensive therapy focused on the diminishing of the risk of developing delirium and its complications.

        Key words: delirium – delirium tremens – withdrawal syndrome – alcohol abuse – alcohol addict – risk factors – hypokaliaemia.
       

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