This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Substance Abuse/ Alcoholism  • Neurology  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We would like to commend Mayo-Smith et al¹ for their attempt to define practice guidelines for delirium tremens, a potentially lethal and commonly mistreated condition. We are concerned, however, that the authors do not clearly recommend intravenous benzodiazepines as the sedative-hypnotic of choice despite sound pharmacological rationale. The alcohol withdrawal results from reduced inhibition from GABA_A receptors and excitation from glutamate (N-methyl-D-aspartate) receptors. Benzodiazepines, barbiturates, and other GABAergic agents are effective, probably owing to cross-tolerance with ethanol at the GABA_A receptor.² The use of titrated intravenous benzodiazepines usually leads to rapid control of these critically ill patients. Furthermore, we believe that the use of -blockers, clonidine, and neuroleptics merely reduces the sympathetic symptoms of inadequately sedated patients without treating the underlying cause or improving outcome. In addition, experimental and clinical evidence contraindicate neuroleptics.^2-3 Treatment protocols that emphasize loading doses of diazepam and symptom-triggered treatment, along with . . . [Full Text of this Article]

AUTHOR INFORMATION
Nicole C. Bouchard, MD; Andrew Meltzer, MD; Robert S. Hoffman, MD

RELATED ARTICLE

Treatment of Delirium Tremens—Reply
Michael F. Mayo-Smith
Arch Intern Med. 2005;165(5):587.
EXTRACT | FULL TEXT