Which medications in the drug class Vitamins and Nutrients are used in the treatment of Delirium Tremens (DTs)?

Updated: Nov 06, 2020
  • Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Vitamins and Nutrients

These agents are used to treat the hypoglycemia and nutrient and electrolyte deficiencies associated with delirium tremens (DTs). Alcoholics usually are deficient in thiamine, which functions as a cofactor for a number of important enzymes, such as pyruvate dehydrogenase, transketolase, and alpha-ketoglutarate dehydrogenase. Deficiency leads to Wernicke encephalopathy, peripheral neuropathy, cardiomyopathy, and metabolic acidosis.

Alcoholics often are also magnesium deficient, due to poor nutritional status and malabsorption. Magnesium stabilizes membranes, helps in the maintenance of potassium and calcium homeostasis, and may protect against seizures and arrhythmias.

Patients suffering from alcoholism may also develop hypoglycemia, due to malnutrition and poor glycogen stores. Additionally, gluconeogenesis is impaired because of a relative reduced redox state resulting from alcohol metabolism, which uses NAD+ as a cofactor for alcohol dehydrogenase and aldehyde dehydrogenase. The relative excess of NADH shifts the pyruvate-to-lactate ratio toward lactate, decreasing the substrate for gluconeogenesis.

Dextrose (D-Glucose)

Dextrose is a monosaccharide absorbed from the intestine and distributed, stored, and used by tissues. Parenterally injected dextrose is used in patients who are unable to obtain adequate oral intake. Direct oral absorption results in a rapid increase of blood glucose concentrations. Dextrose is effective in small doses; there is no evidence of toxicity. Concentrated dextrose infusions provide higher amounts of glucose and increased caloric intake, with minimal fluid volume. Use 1 ampule of 50 mL of a 50% glucose solution (25 g).

Thiamine (Vitamin B-1)

This is used to treat thiamine deficiency, including Wernicke encephalopathy.

Folic acid (Folacin-800)

Dietary deficiency of folic acid is common in alcoholics. Folic acid is an important cofactor for enzymes used in the production of red blood cells.

Magnesium sulfate

Magnesium sulfate is used to treat and prevent seizures. It decreases the amount of acetylcholine liberated at the endplate by the motor nerve impulse. The drug blocks neuromuscular transmission associated with seizure activity. Magnesium also exercises central nervous system depressant effects by blocking the NMDA receptor. Monitor patients carefully; large doses of magnesium sulfate may cause respiratory depression, hyporeflexia, and bradycardia. Infusion should be discontinued if reflexes are absent or if magnesium levels exceed 6-8 mEq/L. Calcium chloride, 10 mL IV of a 10% solution, can be given as an antidote for clinically significant hypermagnesemia.


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