Delirium Tremens and Central Pontine Myelinolysis in a Patient with Alcohol Use Disorder and Pneumonia: a Case Report and a Narrative Review

Abstract

Introduction Delirium tremens (DT) is a serious condition occurring in alcohol withdrawal syndrome. Alcohol consumption may also cause additional health problems, such as respiratory infections or neuropsychiatric conditions such as central pontine myelinolysis. In this clinical scenario, managing DT can be expected to be more compelling and complex. Alcohol decreases coughing and mucociliary clearance and disrupts the immunity of the respiratory system.

Case Here we report on a middle-aged man with alcohol use disorder who had developed DT due to alcohol withdrawal and comorbid pneumonia.

Discussion and Conclusion In this paper, DT, the relation between respiratory infections and alcohol intake, and the correlation of alcohol consumption and central pontine myelinolysis (CPM) are discussed. Also, the literature on alcohol consumption and the additional respiratory and neurologic problems resulting from it are presented.

Zusammenfassung

Einleitung Delirium tremens (DT) ist eine schwerwiegende Erkrankung, die beim Alkoholentzugssyndrom auftritt. Alkoholkonsum kann auch zusätzliche gesundheitliche Probleme wie Infektionen der Atemwege oder neuropsychiatrische Störungen wie die zentrale pontine Myelinolyse verursachen. In diesem klinischen Szenario wird erwartet, dass die Behandlung von DT komplexer und überzeugender ist. Alkohol verringert den Husten und die mukoziliäre Clearance und stört die Immunität des Atmungssystems.

Fall In der unten aufgeführten Forschungsanalyse wurde ein Mann mittleren Alters mit einer Alkoholkonsumstörung, der aufgrund von Alkoholentzug und einer komorbiden Lungenentzündung ein Delirium tremens entwickelte, von unserem Forschungsteam beobachtet und vorgestellt.

Diskussion und Schlussfolgerung Delirium tremens und der Zusammenhang zwischen Atemwegsinfektionen und Alkoholkonsum; und der Zusammenhang zwischen Alkoholkonsum und zentraler pontiner Myelinolyse (CPM) wurden diskutiert. Auch die Literatur zu Alkohol und seinen zusätzlichen respiratorischen und neurologischen Problemen wurde entsprechend der vorliegenden Daten entlastet.

Keywords

alcohol withdrawal - delirium tremens - pneumonia - central pontine myelinolysis

Schlüsselwörter

Alkohol-Entzug - Delirium tremens - Lungenentzündung - zentrale pontine

Publication History

Received: 08 January 2022

Accepted after revision: 14 February 2022

Article published online:
28 April 2022

• References

• 1 Guliyev C, İnce-Guliyev E, Ögel K. Predictors of Relapse to Alcohol and Substance Use: Are There Any Differences between 3 and 12 Months after Inpatient Treatment?. Journal of psychoactive drugs 2021; p. 1-10
• 2 Wright T. et al. Risk factors for delirium tremens: a retrospective chart review. The American journal on addictions 2006; 15 p. 213-219
• 3 Sullivan JT. et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). British journal of addiction 1989; 84 p. 1353-1357
• 4 Yeligar SM. et al. Alcohol and lung injury and immunity. Alcohol 2016; 55 p. 51-59
• 5 Samokhvalov A, Irving H, Rehm J. Alcohol consumption as a risk factor for pneumonia: a systematic review and meta-analysis. Epidemiology & Infection 2010; 138 p. 1789-1795
• 6 Bailey KL, Samuelson DR, Wyatt TA. Alcohol use disorder: A pre-existing condition for COVID-19?. Alcohol 2021; 90 p. 11-17
• 7 Niederman MS. et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. American journal of respiratory and critical care medicine 2001; 163 p. 1730-1754
• 8 Boé DM. et al. Acute and chronic alcohol exposure impair the phagocytosis of apoptotic cells and enhance the pulmonary inflammatory response. Alcoholism: Clinical and Experimental Research 2010; 34 p. 1723-1732
• 9 Sapkota M, Kharbanda KK, Wyatt TA. Malondialdehyde-Acetaldehyde-Adducted Surfactant Protein Alters Macrophage Functions Through Scavenger Receptor A. Alcoholism: Clinical and Experimental Research 2016; 40 p. 2563-2572
• 10 Sapkota M. et al. Malondialdehyde-Acetaldehyde (MAA) Protein Adducts Are Found Exclusively in the Lungs of Smokers with Alcohol Use Disorders and Are Associated with Systemic Anti-MAA Antibodies. Alcoholism: Clinical and Experimental Research 2017; 41 p. 2093-2099
• 11 Szabo G, Mandrekar P. A recent perspective on alcohol, immunity, and host defense. Alcoholism: Clinical and Experimental Research 2009; 33 p. 220-232
• 12 Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ open 2018; 8 p. e022344
• 13 Simou E, Leonardi-Bee J, Britton J. The effect of alcohol consumption on the risk of ARDS: a systematic review and meta-analysis. Chest 2018; 154 p. 58-68
• 14 Abate BB. et al. Sex difference in coronavirus disease (COVID-19): a systematic review and meta-analysis. BMJ open 2020; 10 p. e040129
• 15 Fond G. et al. Association between mental health disorders and mortality among patients with COVID-19 in 7 countries: a systematic review and meta-analysis. JAMA psychiatry 2021; 78 p. 1208-1217
• 16 Schmidt KJ. et al. Treatment of severe alcohol withdrawal. Annals of Pharmacotherapy 2016; 50 p. 389-401
• 17 Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). New England Journal of Medicine 2014; 371 p. 2109-2113
• 18 Hagiwara K. et al. Extensive central and extrapontine myelinolysis in a case of chronic alcoholism without hyponatremia: a case report with analysis of serial MR findings. Internal Medicine 2008; 47 p. 431-435
• 19 Kumar S. et al. Central pontine myelinolysis, an update. Neurological research 2006; 28 p. 360-366