The dilemma of using physical restraint in delirium tremens: a case report

Yogender Kumar Malik, Debasish Basu, Chandrima Naskar


Delirium tremens (DT) is a common presentation in tertiary care hospitals. Refractory DT, though not very common, is a dreaded presentation in any clinical setting. Usually, patients with DT respond to standard doses of benzodiazepines, but sometimes we encounter patients requiring higher than the usual dose. Also, due to the high level of agitation, confusion and hallucinatory behaviour, physical restraint is frequently used in these patients. We hereby report a case of refractory DT in whom the dilemma of using physical restraint and need for higher doses of Benzodiazepine has been highlighted.


Chronic liver disease, Delirium tremens, Hyperthermia, Lorazepam, Mental healthcare act, Physical restraint

Full Text:



Junghanns K, Wetterling T. Alcohol withdrawal and its major complications. Fortschritte der Neurologie-Psychiatrie. 2017;85(3):163-77.

Mayo-Smith MF, Beecher LH, Fischer TL et al. Management of alcohol withdrawal delirium: evidence-based practice guideline. Arch Intern Med. 2004; 164:1405–1412.

Sellers EM, Kalant H. Management of the alcohol withdrawal syndrome. Annu Rev Med. 1991; 42:323–340.

Guthrie SK. The treatment of alcohol withdrawal. Pharmacotherapy: The J Human Pharmacol and Drug Therapy. 1989;9(3):131-43.

Miller FT. Protracted alcohol withdrawal delirium. J substance abuse treatment. 1994;11(2):127-30.

Minnick AF, Mion LC, Johnson ME, Catrambone C, Leipzig R. Prevalence and variation of physical restraint use in acute care settings in the US. Journal of Nursing Scholarship. 2007;39(1):30-7.

McKinely MG. Alcohol withdrawal syndrome. Crit Care Nurse. 2005;25:40-49

Raveesh BN, Gowda GS, Gowda M. Alternatives to use of restraint: A path toward humanistic care. Indian J Psych. 2019;61:S693.

Rao R, Varshney M, Singh S, Agrawal A, Ambekar A. Mental Healthcare Act, 2017, and addiction treatment: Potential pitfalls and trepidations. Ind J psych. 2019;61(2):208.