twenty-eight-day-long delirium tremens paritosh kafle资料.pdf

该【twenty-eight-day-long delirium tremens paritosh kafle资料 】是由【宝钗文档】上传分享，文档一共【3】页，该文档可以免费在线阅读，需要了解更多关于【twenty-eight-day-long delirium tremens paritosh kafle资料 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。-report84722820192019CaseReportJournalofInvestigativeMedicineHighImpactCaseReportsTwenty-Eight-Day-LongDeliriumVolume7:1–3?2019AmericanFederationforMedicalResearchTremensDOI:https:////2324709619847228journals./home/hicParitoshKafle,MBBS1,AmrendraKumarMandal,MBBS1,BinavShrestha,MBBS1,BikashBhattrai,MBBS1,ManjulBhandari,MBBS1,ShambhuBhagat,MBBS1,BijoyShankarKar,MBBS1,DikshyaSharma,MBBS2,andVijayGayam,MD1Abstractmoninday-to-,DT,benzodiazepines,phenobarbitone,midazolam,-Twopercentto5%ofhospitalizedalcoholicpatientsareesti-ious-lookingwhiteHispanicmalewithmilddiaphoresis,matedtosufferfromdeliriumtremens(DT),whichhasatachycardia,tachypnea,putedtomog-mortalityrateofabout1%to15%.monlyraphyscanoftheheadonadmissiondidnotrevealanyintra--relateddementiaandabout24hoursto6days,butintherareinstancethecondi-hepaticencephalopathy,basedonhismentation,Mini--4Inthisarticle,wepresentacaseStateExamination,mildammoniaelevation,ultrasonographicwheremultiplegroups,remarkabledosesofmedicationsevidenceofmildhepaticsteatosiswithoutanyincreasednodu-includingbenzodiazepines,andexceptionallymoreextendedlarityoftheliver,,hepatitisB,andhepatitisfewdecadesearlier,themortalityrelatedtoDTswasesti--downunitandintensivematedtobeashighas15%,butwithimprovementsinunder-careunit(ICU)forseverealcoholwithdrawalandwasman-%to5%.3,6withfluidresuscitation,thiamineandfolicacidweresupple--able;however,onthethirdday,,andbynight,hewasagitatedA48-year-oldmalefromVeteranshelterwithahistoryofandgrosslydisorientedwhilehewasbeingtreatedwithsched-hypertension,alcoholdependence,andalcoholwithdrawalsei-uledintravenous(IV)lorazepamatadose2mgevery6hourszurespresentedtotheemergencydepartmentforworseningalongwithas-,hereportedfeelinganxious,agitated,andexcessivesweatingbutdeniednausea,1InterfaithMedicalCenter,Brooklyn,NY,USAvomiting,headache,auditory,visual,,Brooklyn,NY,-ReceivedNovember15,,,,withhislastCorrespondingAuthor:ParitoshKafle,DepartmentofInternalMedicine,,1545AtlanticAvenue,Brooklyn,NY11213,,withthelastonebeing6monthsEmail:******@BY:(enses/by//)whichpermitsanyuse,reproductionanddistributionoftheworkwithoutfurtheresspages(https://us./en-us/nam/open-access-at-sage).-tientdrugrehabilitationof28daysandwasdevoidofanyalcoholwithdrawalsymptomsthroughouthisstay,-.?-hypnoticsoranxiolytics,,thepatientclinicallywors-receivedaveryhighdoseoflorazepamincludingmidazolampletedisorientation,agita-andeventuallywastreatedwithphenobarbitoneforthecon-tion,aggressivebehavior,andintensetactilehallucinations—-dosebenzo-hallmarksofDTsdespitebeingonescalatingdosesofIVloraz--aminobutyricacid(GABA)’sconformationalchangesacquiredprobablythepossibilityofWernicke’,-DThasnotbeenclearlydefinedinthemedicalliterature,butinduceddementia/amnesticsyndrome;however,(50mg)passingday,thedoseofbenzodiazepinesescalated,andloraz-orlorazepam(10mg)inthefirsthourordiazepam(>200epamwassubsequentlyreplacedwithcontinuousIVinfusionmg)orlorazepam(>40mg)infirst3to4hoursofmanage-,,-dosebenzodiazepineispre-admission,icsofben-,andonthesameday,zodiazepines(diazepam)-neurotransmittersandexertsitseffectoncentralnervoussys--temGABAreceptors,,-,62%resolvedwithin5days,anic,orinfectivecauseswithnor-whereas6%--or-putedaxialtomographyscanofthehead(Figure1),.WereconsideredtocontinuethetreatmentofDTsandHeavyalcoholconsumptionisknownastheriskforpro-restartedhimonmidazolamIVinfusion,whichplateauedhislongeddeliriumaftercessation,whichisalsofoundinoursymptoms,-actingbenzodiazepine(lorazepam),plicatingfactorsseenwithlongeractingadmission,othemix,?-bination,plicatedbytotaperoffboththemedications,andhewaseffectivelytran-neurosurgicalproblemsand3weekslong,withsecondepi--plexKafleetal3comorbiditiessuchasdementiaorheadinjury,asseenintheclinicalpresentation,;4:432--LindbergG,-;62:273-;9:131-,,;11:127-,;32:-:;82:117-,LiangJ,SpigelmanI,(s)declarednopotentialconflictsofinterestwithrespect-totheresearch,authorship,and/,reducessynapticfunction,anddecreasesbehavioralresponsestopositiveallostericmodulatorsofGABAArecep-;63:53-(s)receivednofinancialsupportfortheresearch,author-,,and/;13:246-,-;136:821--,!PotentiationofGABAergictrans--ami-nobutyricacidA-;246:558-,SchwartzRD,SkolnickP,-ulatesgamma-aminobutyricacidreceptor-;83:4071-:///0000-0002-5873-,:///0000-0001-5194-;329:120-,KranzlerHR,-,LichsteinPR,PedenJGJr,BusherJT,:diagnosticandAlcoholwithdrawalsyndromes:areviewofpathophysiology,;154:846-851.