[Alcohol delirium--pathogenesis and therapy]

Alcohol-induced delirium tremens (DT) is a well-known disease with an unpredictable, either favorable or fatal, spontaneous course. The cardinal symptoms are disorientation, hallucinations and autonomic lability. The pathogenesis of DT is still unknown, and the numerous hypothesis have spawned as many therapeutic approaches. Drugs with a cross-tolerance to alcohol have so far proved best. Benzodiazepines and clomethiazole have been considered the drugs of first choice for the past 20 years and more. Improvements in intensive care has helped lower the mortality rate to 3 to 8%. Major tranquilizers with a strong antipsychotic effect and anti-epileptic agents can effectively expand the sedative management of DT. Cerebral convulsions at the beginning of DT appear to dispose the patient to a prolonged course, and preexisting or concomitant disease affecting other organs (complicated DT) clearly prolongs the duration of delirium. The risks and contraindications of clomethiazole are emphasized. The course and outcome of DT is unpredictable--in our patients we found a mortality rate of 3.7% and 12.3% end up in a defective state.