Patients become agitated and confused, with progressive dementia and frontal release signs. Pathologic intoxication is a rare syndrome. It is characterized by repetitive, automatic movements and extreme excitement with aggressive, uncontrolled irrational behavior after ingesting a relatively small amount of alcohol. The episode may last for minutes or hours and is followed by prolonged sleep with amnesia for the event on awakening. Differentiating delirium tremens from the mental changes of acute hepatic insufficiency is very important.
Delirious patients are extremely suggestible and respond well to reassurance.
They generally should not be restrained. Fluid balance must be maintained, and large doses of vitamin C and B-complex vitamins, particularly thiamine, must be given promptly. All patients entering withdrawal are candidates for CNS-depressant drugs, but not all need them. Many patients can be detoxified without drugs if proper attention is paid to psychologic support and reassurance and if the approach and environment are nonthreatening. However, these methods may not be possible in general hospitals or emergency departments.