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עברית
Jul 24, 2023
Contributor: Travis Barlock MD
Educational Pearls:
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Alcohol binds the GABA receptor, which produces an inhibitory response, hence the “depressive” effects of ethanol beverages.
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Over time, alcohol downregulates the GABA receptors, leading to unopposed glutamate activity. Given that glutamate is excitatory, this can lead to seizures.
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Alcohol also suppresses REM sleep; in patients with chronically suppressed REM sleep, the brain starves for dream sleep and it spills over into the wakeful state, inducing a dream-like state when someone is awake.
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The awake dream-like state of delirium tremens (DT) differs from alcohol hallucinosis
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Alcohol hallucinosis presents with visual hallucinations in a wakeful state
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DT presents with a generalized clouding of the sensorium and a dream-like state
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Treatment for DT is better achieved with phenobarbital due to predictable pharmacology
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Phenobarbital acts on GABA and NMDA receptors
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References
1. Davies M. The role of GABAA receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci. 2003;28(4):263-274.
2. Fujimoto J, Lou JJ, Pessegueiro AM. Use of Phenobarbital in Delirium Tremens. J Investig Med High Impact Case Reports. 2017;5(4):4-6. doi:10.1177/2324709617742166
3. Walker, M. Chapter 13: iPads, Factory Whistles, and Nightcaps In: Walker, M, Why We Sleep. Scribner; 2017, pg. 272.
4. Zarcone V. Alcoholism and sleep. Adv Biosci. 1978;21:29-38.
Summarized & Edited by Jorge Chalit, OMSII
