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Dexmedetomidine (DEX) as a Monotherapy in Treating Delirium Tremens (DTs). FREE TO VIEW

Firas Abdulmajeed, MD; Michael Carpenter, CCRN; Nihad Boutros, MD
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Canton Medical Education Foundation, Canton, OH

Chest. 2013;144(4_MeetingAbstracts):367A. doi:10.1378/chest.1658661
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Alcohol withdrawal and its extreme form DTs are common in critically ill patients, with significant morbidity and mortality. Long acting benzodiazepines are the drug of choice; excessive sedation and respiratory depression are yet observed unwanted consequences of their usage. Animal studies and many case reports suggest that the alpha-2 agonist DEX is effective drug for treating DTs. In our abstract we discuss the effectiveness of DEX as mono-therapy for treating DTs.

METHODS: Retrospective review of patients admitted to our medical and surgical intensive care units receiving DEX for treatment of DTs between Jan 2010 and Dec. 2011; recording intensive care and hospital mortality, duration of illness, dose of DEX, need for other treatment (e.g. Benzodiazepines), stopping DEX for bradycardia or hypotension, and the duration of DTs.

RESULTS: 24 patients met the criteria; 16 were treated initially with DEX; 8 patients were initiated on alcohol withdrawal protocol with lorazepam as the main agent, subsequently bridged to DEX as the first failed to control symptoms. All patients were transferred successfully to the medical floor with average duration of illness of 3.4 days. All survived their hospitalization course. The highest infusion rate was 1.4 mcg/kg/hour observed in 6 patients out of the 24. The median accumulative dose of ativan for those 8 patients was 8.14 mg/24 hours in comparison with a median of 16.9 mg/24 hours for those that were solely on benzodiazepines for their DTs in the same era, knowing that APACHE score median for the first group was 17.58 in comparison to 13.7 for the secondly mentioned group. Hypotension and bradycardia did not lead to cessation of DEX administration.

CONCLUSIONS: Dexmedetomidine is an effective mono therapy in the treatment of delirium tremens.

CLINICAL IMPLICATIONS: Usage of Dexmedetomidine in DTs as a monotherapy is safe and effective.

DISCLOSURE: The following authors have nothing to disclose: Firas Abdulmajeed, Michael Carpenter, Nihad Boutros

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