UMEM Educational Pearls

Category: Toxicology

Title: Clinical Predictors for Delirium Tremens in Patients with Alcohol Withdrawal Seizures

Keywords: Delirium tremens, DTs, alcohol withdrawal, seizures (PubMed Search)

Posted: 4/7/2015 by Bryan Hayes, PharmD (Emailed: 4/9/2015) (Updated: 4/9/2015)
Click here to contact Bryan Hayes, PharmD

A new study from South Korea identified 3 potential clinical predictors of developing delirium tremens in patients presenting to the ED with alcohol withdrawal seizures.

  1. Low platelet count
  2. High blood level of homocysteine
  3. Low blood level of pyridoxine

If one or more is present, these findings may help assess alcohol withdrawal patients for the risk of developing DTs.

Application to Clinical Practice

  • The problem is that in the U.S., homocysteine and pyridoxine levels may not be readily available at all institutions.
  • Adjunctive treatment options including vitamin B12, folate, and pyridoxine may be considered if levels are available, but it is unknown if 'treating the numbers' actually prevents development of DTs.
  • At the very least, these clinical predictors may help risk assess patients for appropriate disposition.


Kim DW, et al. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Am J Emerg Med 2015 Feb 23. [Epub ahead of print, PMID 25745798]

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