Podcast 861: Alcohol Withdrawal and Delirium Tremens

Podcast 861: Alcohol Withdrawal and Delirium Tremens

Contributor: Travis Barlock MD

Educational Pearls:

  • Alcohol binds the GABA receptor, which produces an inhibitory response, hence the "depressive" effects of ethanol beverages.

  • Over time, alcohol downregulates the GABA receptors, leading to unopposed glutamate activity. Given that glutamate is excitatory, this can lead to seizures.

  • Alcohol also suppresses REM sleep; in patients with chronically suppressed REM sleep, the brain starves for dream sleep and it spills over into the wakeful state, inducing a dream-like state when someone is awake.

  • The awake dream-like state of delirium tremens (DT) differs from alcohol hallucinosis

    • Alcohol hallucinosis presents with visual hallucinations in a wakeful state

    • DT presents with a generalized clouding of the sensorium and a dream-like state

  • Treatment for DT is better achieved with phenobarbital due to predictable pharmacology

    • Phenobarbital acts on GABA and NMDA receptors

References

1. Davies M. The role of GABAA receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci. 2003;28(4):263-274.

2. Fujimoto J, Lou JJ, Pessegueiro AM. Use of Phenobarbital in Delirium Tremens. J Investig Med High Impact Case Reports. 2017;5(4):4-6. doi:10.1177/2324709617742166

3. Walker, M. Chapter 13: iPads, Factory Whistles, and Nightcaps In: Walker, M, Why We Sleep. Scribner; 2017, pg. 272.

4. Zarcone V. Alcoholism and sleep. Adv Biosci. 1978;21:29-38.

Summarized & Edited by Jorge Chalit, OMSII

Avsnitt(1144)

Podcast 993: Personalized Gene Editing Therapy

Podcast 993: Personalized Gene Editing Therapy

Contributor: Alec Coston, MD Educational Pearls: Disclaimer: this has nothing to do with the ER but is too cool to not talk about. Condition: Carbamoyl phosphate synthetase 1 (CPS1) deficiency Ra...

9 Feb 6min

Tox Talks 2025 Recap 2, Methemoglobinemia and Errors

Tox Talks 2025 Recap 2, Methemoglobinemia and Errors

Contributors: Travis Barlock MD, Ian Gillman PA, Jacob Altholz MD, Jeffrey Olson MS4 In this episode, EM attending Travis Barlock and medical student Jeffrey Olson listen in to the two remaining cases...

4 Feb 41min

Podcast 992: Fentanyl for Asthma

Podcast 992: Fentanyl for Asthma

Contributor: Alec Coston, MD Educational Pearls: BiPAP is often effective in severe asthma, but many patients struggle with mask tolerance due to intense air hunger–driven anxiety, often compounded ...

2 Feb 4min

Episode 991: BRASH

Episode 991: BRASH

Contributor: Aaron Lessen, MD Educational Pearls BRASH Syndrome: Bradycardia Renal Failure AV Nodal Blockade Shock Hyperkalemia  Clinical Features: Profound bradycardia and shock in pat...

19 Jan 2min

Episode 990: Tramadol, or rather, Trama-don't

Episode 990: Tramadol, or rather, Trama-don't

Contributor: Taylor Lynch, MD Educational Pearls: What is tramadol and how does it work? Tramadol is a Schedule IV opioid analgesic used for moderate pain and is often perceived as safer than other ...

12 Jan 5min

Episode 989: Young Strokes

Episode 989: Young Strokes

Contributor: Aaron Lessen, MD Educational Pearls: The Case 24F brought in for anxiety. Patient is tearful, not talking, and potentially hyperventilating. History from boyfriend is that she suddenly ...

5 Jan 3min

Episode 988: Infant Botulism

Episode 988: Infant Botulism

Contributor: Aaron Lessen, MD Educational Pearls: A 2025 multistate outbreak of infant botulism has been linked to ByHeart infant formula As of December 10-17th, there have been at least 51 infants ...

29 Dec 20252min

Carepoint Journal Club: Trauma Discussion

Carepoint Journal Club: Trauma Discussion

Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.

22 Dec 202545min

Populärt inom Vetenskap

p3-dystopia
pojkmottagningen
dumma-manniskor
svd-nyhetsartiklar
kapitalet-en-podd-om-ekonomi
allt-du-velat-veta
det-morka-psyket
rss-vetenskapsradion
rss-ufo-bortom-rimligt-tvivel
halsorevolutionen
rss-vetenskapsradion-2
paranormalt-med-caroline-giertz
sexet
4health-med-anna-sparre
dumforklarat
medicinvetarna
rss-spraket
bildningspodden
hacka-livet
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli