Surely the NEJM could do a better review of delirium tremens

2.5 out of 5 stars Recognition and Management of Withdrawal Delirium (Delirium Tremens). Schuckit MA. N Engl J Med 2014 Nov 27;371:2109-2113. No abstract available This is an amazingly inept paper, even by the traditionally low standards of the New England Journal‘s  “Review Article” section. It was written by a psychiatrist who — on the basis of this piece — seems not to deal with severe alcohol withdrawal or delirium tremens at all. At times, the author does not appear to appreciate the serious nature of DTs and the difficulty of treating the condition adequately. For instance, he states that “treatment is best carried out in a locked inpatient ward or an ICU.” I would suggest that the thought of managing a patient with  DTs in a locked (presumably psychiatric) ward is — to use the technical term — nuts. But Dr. Schuckit is not done. Later on he writes: “The doses needed to control agitation and insomnia vary dramatically among patients and can be prodigious (e.g., >2000 mg of diazepam in the first 2 days in some patients); this underscores the advisability of providing treatment in a hospital, preferably in an ICU.” Excuse me? It is only “advisable” to treat DTs in the hospital? I’d say it’s damned mandatory. It is just beyond me why the author does not say simply: “Patients should be treated in the ICU.” Full stop. Although the author does say that the patient should be worked-up...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical alcohol withdrawal delirium tremens DTs review article Source Type: news