Sober Sully — Alcohol Withdrawal & Delirium Tremens
Tremors at hour 6, seizures at 24, DTs at 72 — CIWA drives the dose
Sully checks himself in shaking so hard he cannot hold his coffee cup. By the second night he is arguing with people who are not in the room.
Sully drank daily for fifteen years and stopped cold three days ago. Withdrawal starts with tremor, anxiety and diaphoresis within hours, can progress to seizures within a day, and peaks as delirium tremens with hallucinations, autonomic storm and confusion by 48–96 hours. Benzodiazepines are the mainstay, dosed to the CIWA-Ar score, with thiamine given before glucose to prevent Wernicke's encephalopathy.
Read Sober Sully's full story →The story arc
The setup
Sully drinks a fifth of vodka daily and has not had alcohol in eighteen hours.
The turn
His hands tremble, he is sweating through his gown, his pulse is 112, and he keeps asking when he can go outside.
The crisis
On night two he sees bugs crawling on the blanket, his blood pressure spikes to 178/100, and he has a brief tonic-clonic seizure.
The save
The nurse gives thiamine before any dextrose, doses lorazepam by the CIWA-Ar protocol, keeps the room dim and quiet, and pads the side rails.
NCLEX study section — Alcohol Withdrawal & Delirium Tremens
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Mental Health
Take this chapter into practice questions on the same topic.