Use of a combination of dexmedetomidine and magnesium sulfate as a multimodal approach to the treatment of alcoholic delirium

Introduction
The search for an effective sedation schedule in managing delirium tremens that would ensure an adequate sedation level and good safety profile is an urgent problem of modern intensive care medicine. In this respect, the use of dexmedetomidine combined with magnesium preparations seems to be promising.

Material and methods
A quasi-randomized prospective observational study was conducted on 80 patients with alcoholic delirium, who were divided into 4 groups. Assessment parameters were delirium duration, mean arterial pressure and heart rate, and plasma magnesium, urea, creatinine, transaminase, cortisol, and serotonin levels. The control-group patients underwent standard sedation therapy with benzodiazepines. In group 1, standard sedation was supplemented by magnesium sulphate. In group 2, dexmedetomidine infusion was used. In group 3, dexmedetomidine was supplemented by the correction of hypomagnesemia.

Results
The duration of delirium proved to be significantly shorter in all study groups (3.4 ± 0.6 days in group 1; 1.55 ± 0.61 days in group 2) as compared to the control (5.4 ± 1.48 days), P < 0.001, being the shortest in group 3 (1.1 ± 0.18 days), P < 0.001. Cases of hypotension were detected only in the control group (2 cases [10%]) and group 1 (4 cases [20%]). The patients of groups 2 and 3 showed significant improvement in plasma levels of cortisol (16.7 ± 2.25 nmol L–1; 15.62 ± 1.63 nmol L–1) compared with the control (18.77 ± 2.76 nmol L–1), P = 0.019; P = 0.003. Serotonin level was higher in the experimental group 3 (87.8 ± 7.32 ng mL–1) as compared to the control (62.81 ± 9.81ng mL–1) and group 2 (71.73 ± 9.61 ng mL–1), P < 0.001.

Conclusions
Dexmedetomidine infusion combined with magnesium sulphate proved to be effective in the treatment of patients with alcohol delirium.