Adjuvant dexmedetomidine in treatment of alcohol withdrawal delirium: Case series

Abstract

Alcohol withdrawal delirium is a medical emergency with mortality rates of 20–50% without treatment. Benzodiazepines (BZDs) (gamma-aminobutyric acid receptor agonists) are the mainstay of treatment. Alcohol withdrawal delirium is associated with sympathetic hyper-activity and marked agitation, which in severe cases respond poorly to BZDs alone. Very high doses of BZDs pose risk of respiratory depression and further complications such as aspiration pneumonia which can worsen the treatment outcome. Dexmedetomidine is a selective Alpha-2 adrenergic agonist which has been approved by US Food and Drug Administration for short-term sedation of intubated and mechanically ventilated adult patients in intensive care unit settings and for sedation of non-intubated patients during invasive procedures. Its unique sedative, sympatholytic, and respiratory sparing properties can supplement and can reduce the dose requirement of BZDs while managing such cases. We present three cases of severe alcohol withdrawal delirium [delirium tremens (DT)] who responded poorly to initial BZD treatment but responded well to adjunctive dexmedetomidine infusion. Dexmedetomidine is a pragmatic adjunct to BZDs in severe delirium tremens.

Keywords

• alcohol withdrawal delirium
• alpha-2 agonist
• delirium tremens treatment
• dexmedetomidine