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Case Reports in Critical Care
Volume 2014, Article ID 638493, 3 pages
Case Report

Repetitive Myocardial Infarctions Secondary to Delirium Tremens

1Department of Surgery, Monmouth Medical Center, Long Branch 300 2nd Avenue, Long Branch, NJ 07760, USA
2Department of Trauma & Critical Care Surgery, Jersey Shore University Medical Center, Neptune, NJ 07753, USA

Received 5 June 2014; Accepted 28 July 2014; Published 12 August 2014

Academic Editor: Chiara Lazzeri

Copyright © 2014 David Schwartzberg and Adam Shiroff. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.