Case ReportDexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report
Introduction
Dexmedetomidine, a very selective α2-adrenergic agonist, has sedative, analgesic, anxiolytic and sympatholytic effects mediated via central receptors, with a predictable hemodynamic profile and without inducing significant respiratory depression [1], [2]. The half-life of dexmedetomidine is only 2 to 3 h, shorter than that of clonidine, which makes it relatively easy and safe to titrate by continuous intravenous infusion. Dexmedetomidine alleviates the ethanol withdrawal symptoms in rats [3] and has shown some neuroprotective effects [4]. Dexmedetomidine has been used recently in cases of opioid and benzodiazepine withdrawal [5]. We report a clinical case of a complicated alcohol withdrawal delirium in which dexmedetomidine was used as an adjuvant.
Section snippets
Case report
A 50-year-old male was admitted to a referral center because of severe delirium and violent behavior. His past medical history was significant for severe alcohol dependence, without other drug abuse, and hypertension, which was medicated properly by candesartan 18 mg a day. He had been hospitalized over 10 times during the last 15 years in a psychiatric department for 3 to 5 days' periods because of alcohol-induced hallucinations and alcohol withdrawal delirium; the last of those had occurred
Discussion
In this case, even a low dose of dexmedetomidine added on the standard treatment resulted in a rapid and successful response to complicated alcohol withdrawal delirium. Previous case reports have concentrated more on opiate, benzodiazepine and polysubstance withdrawals [5], [6]. On the ground of this case, practice guidelines cannot be outlined, but the clinical experience opens prospects for the use of dexmedetomidine as an adjuvant in the treatment of complicated alcohol withdrawal delirium,
References (6)
Alpha2-adrenoceptor agonists: analgesia, sedation, anxiolysis, haemodynamics, respiratory function and weaning
BaillieÁre's Clin Anaesthesiol
(2000)- et al.
Dexmedetomidine alleviates ethanol withdrawal symptoms in the rat
Alcohol
(1997) - et al.
Dexmedetomidine produces its neuroprotective effect via the α2A-adrenoceptor subtype
Eur J Pharmacology
(2004)
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