Search results

The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

There is some evidence that suggest a higher dietary total antioxidant capacity (DTAC) is associated with a lower risk of metabolic syndrome (MetS). Considering the conflicting results in this field, this paper aims to provide a comprehensive summary of studies on the association of DTAC and components of MetS.

A systematic review of articles indexed in PubMed, Scopus and Google Scholar, published from inception to September 2018, with defined keywords, was done. Duplicate or irrelevant reports were screened out and data were extracted through critical analysis. Finally, among the 353 articles, 19 articles met the inclusion criteria.

The included cohort studies revealed that higher DTAC was associated with reduced risk of MetS. Also, the association between DTAC and mortality risk of MetS was insignificant in these studies. The case–control studies showed high DTAC is inversely associated with MetS, its components and complications. The randomized controlled trials found that changes in DTAC were negatively correlated with oxidized low-density lipoprotein cholesterol and there was a positive association between DTAC and subjects’ weight and body mass index. Finally, results from the cross-sectional studies were inconsistence in this regard.

The assessed relationship between MetS or its components with DTAC is inconsistent in the included studies. Different sample size, dietary assessment tools, DTAC index values and geographical location may justify the observed inconsistencies. It seems that further studies are needed to reveal more confident and reliable findings.