Repetitive Myocardial Infarctions Secondary to Delirium Tremens. (12th August 2014)

• Record Type: Journal Article
• Authors: Schwartzberg, David; Shiroff, Adam
• Other Names: Lazzeri Chiara Academic Editor.
• Is Part Of: Case reports in critical care. Volume 2014(2014)
• Publication Date: 2014-08-12
• Subjects: Critical care medicine -- Periodicals; Emergency medicine -- Periodicals; Medical emergencies -- Periodicals; 616.02805
• DOI: 10.1155/2014/638493
• Languages: English
• ISSNs: 2090-6420

Abstract

Abstract : Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.