Poster
175
(#175) Altered Mental Status in the Acute Psychiatry Setting: Delirium Tremens and Sepsis
Psych Congress 2025
Abstract: Background
Delirium tremens (DT) is a rare and severe form of alcohol withdrawal that can be fatal. When concurrent with sepsis (a life-threatening form of infection), it can worsen patient prognosis. There are limited guidelines for managing DT in critically ill patients, however prompt recognition remains important for improving survival. Treatment includes rehydration, nutrition, symptom relief, and addressing comorbid conditions [1]. Benzodiazepines are typically used for DT [2], while sepsis is treated with broad-spectrum IV antibiotics, as delayed treatment worsens outcomes [3].
Case Presentation
This is a case of a 41-year-old male with alcohol use disorder and hypertension who presented to the psychiatric ER for alcohol detox. He appeared ill with tachycardia, tachypnea, confusion, and a swollen right hand. The patient's last alcoholic beverage was two days prior. Workup revealed alcohol withdrawal and sepsis due to Group A Strep. On ER arrival, he was administered cefepime and lorazepam and placed on Bipap. Patient received vancomycin, but continued to decompensate. Despite aggressive treatment with benzodiazepines and antibiotics, the patient became hemodynamically unstable, coded, and passed away several hours after initial presentation.
Conclusions
This case highlights the importance of early diagnosis and treatment of DT in the setting of sepsis to improve outcomes in critically ill patients.
References
Dixit D, et al. Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients. Pharmacotherapy. 2016.
Grover S, Ghosh A. Delirium Tremens: Assessment and Management. J Clin Exp Hepatol. 2018.
MartÃnez ML, et al. Antibiotic treatment in patients with sepsis. J Thorac Dis. 2020.
Short Description: This case describes a 41-year-old male with alcohol use disorder presenting with delirium tremens complicated by sepsis from Group A Streptococcus. Despite prompt administration of benzodiazepines and broad-spectrum antibiotics, the patient deteriorated rapidly and passed away. This case underscores the critical need for early recognition and aggressive management of delirium tremens when concurrent with sepsis, highlighting challenges in treating these life-threatening conditions in critically ill patients.
Name of Sponsoring Organization(s):
Delirium tremens (DT) is a rare and severe form of alcohol withdrawal that can be fatal. When concurrent with sepsis (a life-threatening form of infection), it can worsen patient prognosis. There are limited guidelines for managing DT in critically ill patients, however prompt recognition remains important for improving survival. Treatment includes rehydration, nutrition, symptom relief, and addressing comorbid conditions [1]. Benzodiazepines are typically used for DT [2], while sepsis is treated with broad-spectrum IV antibiotics, as delayed treatment worsens outcomes [3].
Case Presentation
This is a case of a 41-year-old male with alcohol use disorder and hypertension who presented to the psychiatric ER for alcohol detox. He appeared ill with tachycardia, tachypnea, confusion, and a swollen right hand. The patient's last alcoholic beverage was two days prior. Workup revealed alcohol withdrawal and sepsis due to Group A Strep. On ER arrival, he was administered cefepime and lorazepam and placed on Bipap. Patient received vancomycin, but continued to decompensate. Despite aggressive treatment with benzodiazepines and antibiotics, the patient became hemodynamically unstable, coded, and passed away several hours after initial presentation.
Conclusions
This case highlights the importance of early diagnosis and treatment of DT in the setting of sepsis to improve outcomes in critically ill patients.
References
Dixit D, et al. Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients. Pharmacotherapy. 2016.
Grover S, Ghosh A. Delirium Tremens: Assessment and Management. J Clin Exp Hepatol. 2018.
MartÃnez ML, et al. Antibiotic treatment in patients with sepsis. J Thorac Dis. 2020.
Short Description: This case describes a 41-year-old male with alcohol use disorder presenting with delirium tremens complicated by sepsis from Group A Streptococcus. Despite prompt administration of benzodiazepines and broad-spectrum antibiotics, the patient deteriorated rapidly and passed away. This case underscores the critical need for early recognition and aggressive management of delirium tremens when concurrent with sepsis, highlighting challenges in treating these life-threatening conditions in critically ill patients.
Name of Sponsoring Organization(s):
