[Respiratory depression in delirium tremens patients treated with phenobarbital. A retrospective study]

Delirium tremens (DT) is the most severe manifestation of alcohol withdrawal which--if untreated--has a high rate of mortality. Barbiturates are the most effective drug but respiratory depression may occur. In the present study we investigated the frequency of respiratory problems in DT patients treated with phenobarbital.

We examined the medical records of patients who were treated as inpatients in 1998-2006 and discharged with the ICD-10 diagnoses F10.4 (alcohol withdrawal delirium) or F10.5 (alcohol induced psychotic disorder). Patients with pre-DT and full blown DT were included in the study.

While we did not detect any respiratory problems among patients with pre-DT, we found 9 cases among 73 patients with full blown DT, 5 of which were considered serious. In two of these the frequency of respiration (FR) was decreased (5-6 per min). Both cases occurred in the same patient at two different admissions. It was not considered necessary to move the patient to the Intensive Care Unit (ICU). Three patients developed pneumonia and were moved to the ICU, one of whom developed a life-threatening sepsis. One patient with chronic emphysema died due to ketoacidosis. The death could not be attributed to the phenobarbital treatment.

In conclusion, we found that the frequency of phenobarbital-induced respiratory depression was low. However, if the DT was complicated with pneumonia, life-threatening respiratory insufficiency could be the outcome. An intensive focus on the patient's somatic condition in DT is therefore recommended, and it should always be possible to move the patient to the ICU.