The management of severe ETOH withdrawal and Delirium Tremens:
1. Consider alternative diagnoses
Here is my DT protocol
2. Start treatment with diazepam
3. If you reach 200 mg, switch to phenobarb or intubate and give propofol
4. Your goal is to get your patient sleepy, but arousable with a HR<120
The citation for the CCM article is (Crit Care Med 2007;35:724)
I also discuss a listener email regarding succinylcholine and whether it causes increased oxygen consumption.
In short: Roc Rocks and Sux Sucks! (that one is for you Reub)
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Hi, my name is Scott Weingart. 
{ 5 comments… read them below or add one }
roc on.
Hey!
Whats Your take on haloperidol for Delirium in general and DT specifically?
Our Internists like Haloperidol + clometiazol (Distraneurin®)
THX & keep up the GREAT work! Gregor, Slovenia
For delerium, it’s great!
for DTs it is deadly b/c it masks the symptoms without treating the cause. Of course, no true evidence for any of this. Dr. Goldfrank may say that with the management he has outlined, his hospitals mortality rates went from very high to virtually nil for this disease. Do with that what you will.
Scott,
I like the valium idea in principle but isn’t that selecting a therapy on the assumption that your admitting services don’t know how to manage DTs? I guess my concern would be that we shouldn’t necessarily be giving one med over the other because we are hoping to prevent a mistake we don’t know will happen.
Are there any other disease processes we approach like this?
MJP
Matt-
It is a valid point. However, even if you eliminate that consideration, diazepam is still the ideal agent b/c it lets you see it’s full effects in ~5 minutes after dosing. We have had stacking dose problems with lorazepam and of course midazolam is too short acting unless you start a drip.
scott