White fever, or alcoholic delirium

White delirium tremens, or acute metal psychosis is observed in patients with alcohol dependence in the II-III stages of the disease and is characterized by a combination of delirious syndrome and expressed somatovegetative, neurological disorders.

What causes the white fever?

The main causes of white fever:

• heavy and long binges;
• use of surrogates of alcohol;
• severe somatic pathology;
• organic brain damage.

The pathogenesis of alcoholic delirium is not known to the end, presumably, the metabolism of the neurotransmitters of the central nervous system and severe, especially endogenous intoxication have a great influence.

Symptoms of white fever

According to epidemiological studies, most often the first white fever develops not earlier than 7-10 years of the existence of the unfolded stage of alcoholism. Alcohol delirium develops usually at the height of alcohol withdrawal syndrome (usually on the 2nd-4th day) and, as a rule, manifests in the evening or at night. Early signs of an upcoming white fever are anxiety and restlessness of the patient, marked anxiety and persistent insomnia. There are signs of arousal of the sympathoadrenal system - pallor of the skin, often with a cyanotic shade, tachycardia and hypertension, hyperhidrosis, mild hyperthermia. To some extent, there are always present vegetative disorders (ataxia, muscle hypotension, hyperreflexia, tremor). Observed characteristic violations of water-electrolyte balance (dehydration, hyperaemia, metabolic acidosis, etc.), changes in the blood picture (leukocytosis, leukocyte shift left, increased erythrocyte sedimentation rate, elevated bilirubin, etc.), subfebrile condition.

Vegetative and neurological disorders occur before the onset of consciousness disorders and persist for a long time after their reduction. Then, to the disorders described above, pareidol illusions are added (flat images of a variable, more often fantastic content, usually their basis is actually existing drawing, ornament, etc.). The illusory perception of the environment is quickly replaced by the appearance of visual hallucinations. Psychotic disorders can be unstable: when the patient is activated, hallucinatory disorders at the time can be reduced and even completely disappeared.

Reduced forms of white fever

For hypnagogic delirium, numerous bright, scene-like dreams or visual hallucinations are characteristic when falling asleep, closing the eyes. The increase in psychotic symptoms is noted both in the evening and at night, characterized not by a pronounced fear, the affect of surprise, typical for delirious disorders, somato-vegetative symptoms. The content of hallucinations varied: there may be awesome pictures (for example, a dangerous pursuit) and adventurous adventures. In some cases, the patient is transferred to a hallucinatory conditioned environment, which indicates a partial disorientation. When opening the eyes or awakening, a critical attitude to what is seen is not restored immediately and this can affect the behavior and statements of the patient. Hypnagogic white fever lasts, as a rule, 1-2 nights, can be replaced by different in structure and form of alcoholic psychoses.

The hypnagogic white fever of fantastic content (hypnagogic onyricism) differs from the above-described variant in the fantastic content of copious, sensually bright visual hallucinations, a scene-like hallucinatory disorder with a consistent change of situations. It is noteworthy: when opening the eyes dreams are interrupted, and when closed, they resume again and, thus, the development of the hallucinatory episode is not interrupted. With this form of delirium, it is not the affect of fear that is more prevalent, but interest and surprise. Another distinguishing feature - disorientation in the surrounding (as a permanent feature). Duration and outcomes are similar to the hypnagogic delirium.

Hypnagogic white fever and hypnagogic onyricism are not identified in the ICD-10 as separate nosological forms.

Delirium without delirium, white fever without white fever (delirium delicacy, trembling syndrome) - I. Salum. (1972) (F10.44 *) is an atypical form characterized by the absence of hallucinations and delusions in the clinical picture. It arises sharply. Major disorders contain neurologic symptoms, expressed to a large extent: distinct, gross tremor, ataxia, sweating. Infringements of orientation in time and space transitory. The affect of anxiety and fear is permanent. Behavior is dominated by confusion, fussiness, restlessness, excitement. The flow of this form of delirium is short-term - 1-3 days, recovery is more often critical. The transition to other forms of delirium is possible.

With abortive white fever (F0.46 *), prodromal phenomena are usually absent. In the clinical picture, single visual illusions and microscopic hallucinations are observed; Of the other hallucinatory disorders, acoasms and phonemes are most often observed. The affect of anxiety and fear is similar to other forms of delirious confusion of consciousness. Delusional disorders are rudimentary, impaired behavior, transient. Neurological disorders are not pronounced.

In the abortive course of delirium and the relatively shallow dullness of consciousness, patients may have critical doubts about the reality of what is happening, even during hallucinatory experiences. The degree of criticality of the patient to the transferred experiences increases with the recovery and the associated disappearance of delirious symptoms. The duration of abortive delirium is up to 1 day. The output is critical.

Typical, or classic white fever

With typical white fever, the symptoms flicker from a few hours to a day, after which hallucinations become permanent. Alcoholic delirium in its development undergoes several successive stages.

The prodromal period

In this period, usually lasting several days, sleep disorders (nightmarish, frightening dreams, fears) are prevalent, the volatile affect is predominant, asthenic complaints are constant. In 20% of cases, the development of white fever is preceded by large and, more rarely, abortive epileptic seizures that occur more often on the first or second day of the existence of alcohol withdrawal syndrome. On the 3-4th day from the onset of the development of alcohol withdrawal syndrome epileptic seizures are rare. In other cases, delirium may develop after an episode of verbal hallucinations or a flash of acute sensual raving. When diagnosing alcoholic delirium, one should not forget about the possible absence of a prodromal period. I

The first stage

The mood changes that were present in the disease extension become more noticeable, they observe a rapid change of the opposite with the affect: depression, anxiety or fearfulness are easily replaced by euphoria, causeless merriment. Patients are overly talkative, restless, restless (acacia). The speech is fast, inconsistent, slightly incoherent, attention is easily distracted. Mimicry and movements are lively, fast, dramatically changeable. Often observed disorientation or incomplete orientation in place and time. Orientation in the self, as a rule, is preserved even in the unfolded stages of the white fever. For patients characterized by mental hyperesthesia - a sharp increase in susceptibility when exposed to various stimuli, sometimes even indifferent. There are bursts of vivid memories, imagery, visual illusions; sometimes there are episodes of auditory hallucinations in the form of akoazmov and phonemes, mark different elements of figurative delirium, by the evening all symptoms sharply increase. Night sleep is disturbed, frequent awakenings are observed in a state of anxiety.

Emotional and psychomotor agitation, rapid change of affect, significant diagnostic signs for distinguishing white fever from alcoholic withdrawal syndrome with predominance of mental component. In differential diagnosis it is necessary to distinguish the initial stage of development of white fever and a hangover state characterized by a typical monotonous depression-anxious affect.

The second stage

To the clinical picture of the first stage, pareidolia is added - visual illusions of fantastic content. They can be black and white or colored, static or dynamic. Characterized by hypnagogic hallucinations of varying intensity. The dream is still intermittent, with awesome dreams. During awakenings, a patient can not immediately distinguish a dream from reality. Hyperesthesia increases, photophobia increases. Light intervals are possible, but they are short-lived. Snaplike experiences alternate with the state of relative wakefulness, with deafening.

The third stage

At the III stage, complete insomnia is observed, true visual hallucinations occur. Characteristic visual zoological hallucinations (insects, small rodents, etc.), tactile hallucinations (most often in the form of a very realistic sense of the presence of a foreign object - a thread or a hair in the mouth), verbal hallucinations are possible that are mostly threatening. The orientation in place and time is lost, but is preserved in one's own personality. Significantly, there are hallucinations in the form of large animals or fantastic monsters. Affective disorders are labile, fear, anxiety, confusion prevail.

At the height of delirious disorders, the patient is an interested spectator. Hallucinations are characteristically scenic or reflect certain situations. Can be single or multiple, often colorless. When deepening the white fever are joined and auditory, olfactory, thermal, tactile, hallucinations of a general feeling. According to different liters, hallucinatory phenomena are not just diverse, but complex, combined, combined. Often meet visual hallucinations in the form of cobwebs, threads, wires, etc. Disorders of the body scheme are reduced to sensations of a change in the position of the body in space: the surrounding objects begin to swing, fall, rotate. The sense of time changes, for the patient it can be shortened or lengthened. Behavior, affect, delusional statements correspond to the content of hallucinations. Patients are fidgety, they can hardly stand on the spot. In connection with the prevailing affect of fear, patients try to escape somewhere, go away, hide, shake something off themselves, knock down or rob, turn to the imaginary interlocutors. The speech in this case is jerky, consists of short phrases or individual words. Attention becomes over-attracted, the mood is extremely volatile, facial expressions are expressive. Within a short time each other is perplexed, complacent, surprised, desperate, but most often and most constantly there is fear. In delirium, delirium is fragmented and reflects hallucinatory disorders, the content here is dominated by delirium of persecution, physical destruction, less often - jealousy, adultery. Delusional delirium disorders are not generalized, they are affectively saturated, specific, unstable, completely dependent on hallucinatory experiences.

Patients are highly suggestible. For example, if a patient is given a sheet of clean white paper and asked to read what he has written, he sees the text on this sheet and tries to reproduce it (Reichardt's symptom); the patient starts a long conversation with the interlocutor, if you give him a switched off handset or some other thing called a telephone receiver (Aschaffenburg's symptom). When pressing on closed eyes and asking specific specific questions, the patient has corresponding visual hallucinations (Lilmann's symptom). It should be borne in mind that the signs of increased suggestibility arise not only at the height of psychosis, but also at the very beginning of its development, and at its end, when acute symptoms are reduced. For example, you can call the patient persistent visual hallucinations after the end of the delirium, if you make him look at the shiny objects (Bekhterev's symptom).

Another interesting point: the symptoms of psychosis can weaken under the influence of external factors - distractions (talking with a doctor, medical staff). A symptom of an awakening is typical.

In the III stage of a typical white fever, bright (lucid) gaps can be observed, while the patients notice a significant asthenic symptomatology. By evening and at night, there is a sharp increase in the severity of hallucinatory and delusional disorders, psychomotor agitation is increasing. Anxiety can reach the level of a rant. By the morning the described state passes into a sleep.

On this development of white fever in most cases ends. The way out of psychosis is, as a rule, critical - after a deep long sleep, but there is a lytic - gradual; the symptoms can be reduced wave-like, with alternating weakening and the resumption of psychopathological symptoms, but at a less intense level.

Memories of the patient about the experience of a mental disorder are fragmentary. He can remember (often in great detail) the content of painful experiences. Hallucinations, but does not remember and can not reproduce what was happening around him in reality, his behavior. All this is subject to partial or complete amnesia.

The end of white fever is accompanied by intensely expressed emotional-hyperesthetic weakness. The mood is changeable: they observe the alternation of tearfulness, depression, elements of faintheartedness with causeless sentimental contentment and enthusiasm; asthenic reactions are necessary. 

After a reduction in the clinical picture of delirium, transitional syndromes are observed in some cases. These include residual raving uncritical attitude to the experience or individual delusions, mild hypomaniacal (more often in men), as well as depressive, subdepressive or astheno-depressive conditions (more often in women).

Structural-dynamic characteristics of the mental process in part and іmenene, but expressed incoherence, the decay of thinking is not observed. After exiting from the psychotic state, slow down is noted, a small product of notes. Thinking, but it is always sufficiently coherent, coherent. Possible manifestations of a kind of alcoholic resonance, alcoholic humor

The course of white fever, as a rule, is continuous (in 90% of cases), but it can be intermittent: 2-3 attacks are observed, separated by light intervals of up to a day.

The duration of alcoholic delirium averages from 2 to 8 days, in a small percentage of cases (up to 5) delirium can last up to days.

Mixed forms of white fever

Alcohol delirium can be structurally complicated: it is possible to join delusional experiences, the emergence of ideas of self-blame, harm, attitude, persecution. Hallucinations can become more complex, scenic (domestic, professional, less religious, battle or fantasy plan). In such cases it is permissible to talk about mixed forms of white fever, among them there are systematized delirium and delirium and expressed verbal hallucinations. These forms are not identified in ICD-10.

Systematized white fever

The development of stages I and II does not differ from that of a typical white fever. At the third stage, multiple scenic-like visual hallucinations begin to predominate in the clinical picture. The content is dominated by scenes of persecution, while the patient is always an object of assassination and chase. The behavior of the patient is dictated by the experiences experienced: he tries to escape, hide, find a safe hiding place from the pursuers. Affect of fear - pronounced, permanent, persistent. Less common are visual hallucinations with a predominance of public spectacles or erotic scenes, whose witness is a patient. Some authors emphasize the constancy of drinking subjects. In such cases, the affect of surprise, curiosity prevails. Visual hallucinations co-exist with a variety of illusions, pareidolias, false recognitions, a false, constantly changing orientation in the surrounding environment. In this case, they talk about the development of visual hallucinosis in the structure of alcoholic delirium.

Delusional statements are interrelated with the content of hallucinations, are of a determining nature and vary depending on the change in hallucinations. The harm, due to the sequence of the story and the "delirious details", is reminiscent of a systematic one.

The confusion of consciousness does not reach a deep level, since the patient, when exiting from a morbid state, is able to reproduce the content of painful experiences. Vegetative and neurological disorders are shallow. The duration of psychosis is several days to a week or more. If the course of psychosis has acquired a princely character, then the output is always logical, with residual delirium.

White fever with pronounced verbal hallucinations

In this case, they speak of the development in the structure of delirium of verbal hallucinosis. Together with the characteristic intense visual, thermal, tactile hallucinations, disorders of the body scheme, visual illusions, there are constant verbal hallucinations. The contents of hallucinations are similar to other types of white fever, usually of a frightening nature. That is why the affect is determined primarily by anxiety, tension, fear. Delusional remarks resemble those in systematized delirium. However, in this case, it should be noted: delusional statements are not supported by argumentation, so there is no need to talk about systematized delirium. In addition, they reveal signs of figurative delirium - confusion, ideas of delusional dramatization, a symptom of a positive twin, spreading over a multitude of faces. Orientation in place and time is broken insignificantly: the depth of obscuration of consciousness, despite the abundance of productive disorders, is negligible. Neurological and vegetative disorders are also not expressed. Duration of psychosis - from several days to several weeks. In the latter case, painful disorders disappear gradually, with residual delirium.

Heavy fever

The allocation of a group of severe white fever is associated with pronounced somatovegetative and neurological disorders, features of psychopathological disorders, and with the possibility of a lethal outcome. Heavy delirium occurs usually with alcoholism of II-III or III stage with preservation of high tolerance and a constant form of alcohol consumption. The development of severe delirium is often preceded by convulsive seizures. There are two forms of heavy delirium - professional and mussing.

Professional white fever (delirium with professional delirium) F10.43 *

The psychosis can begin with typical disorders, then the transformation of the clinical picture is observed, as a rule, its weighting. In this case, the intensity of hallucinatory phenomena decreases, the delirium of persecution weakens or disappears. Affective disorders become monotonous. The motor disorders and the behavior of the patient also change. Instead of different in content, well-coordinated actions that require dexterity, strength, considerable space, monotonous movements of limited scale and stereotyped character begin to prevail. Patients perform the usual actions for them, including professional: dressing and undressing, counting money, signing papers, washing dishes, ironing, etc. The distraction by external stimuli in this state gradually decreases, and in the future can disappear completely. In the initial period, delirium with professional delirium is observed by the changing false recognitions of the surrounding people and the constantly changing false orientation in the situation. Consciousness of one's self is always preserved. When the state becomes heavier, false recognitions disappear, the movements become more and more automated. Symptoms of stunning occur already during the day, this also indicates a worsening of the condition.

Professional white fever, as a rule, is accompanied by full amnesia. Less often in memory are kept separate memories, related to the beginning of the development of psychosis. When the condition is heavier, the professional delirium can go into a mutating state, and transient states can also arise in the form of a transient dysme- nesic, Korsakov syndrome, or pseudoparachy.

Muttering white fever (delirium with mumbling) F10.42 *

Usually occurs after professional delirium, less often - after other forms of white fever in their autochthonous adverse course or intercurrent infection. Mutant white fever can develop very quickly, for hours or days, with virtually no hallucinatory delusions. This condition is characterized by a combination of deep obscuration of consciousness, specific disorders of the motor sphere and pronounced somatoneurological disorders. Motor excitement is observed and limited by the inhabitants, it is limited by vestigial grasping movements, tightening, smoothing, blunting (karfology). Often noted myoclonic twitching of different muscle groups, choreoform hyperkinesis. Speech excitement - a set of simple, short words, syllables, interjections; the voice is quiet, devoid of modulations. Symptoms of stunning increase with weighting of the condition, they occur in the night and daytime. Recovering is possible, after that the entire period of psychosis is amnesiac.

It should be noted, with mussening white fever, neurological and vegetative disorders may take the leading place in the clinical picture. With it, tachycardia, sharp changes in blood pressure, more often its decline until the development of collapoid states, deaf cardiac tones, hyperhidrosis, development of oliguria up to anuria (an unfavorable clinical symptom); often there are subcutaneous hematomas (fragility of capillaries, a violation of blood coagulability); observe hyperthermia (up to 40-41 ° C), tachypnea, superficial, intermittent breathing. Neurologic symptoms are presented by ataxia, tremor, hyperkinesis, symptoms of oral automatism, muscular tonus disorders, stiff neck muscles; possibly incontinence of urine and feces (an unfavorable clinical sign).

As the clinical picture becomes heavier, there are amenitively-like disorders, verbal and motor incoherence.

Atypical white fever

To atypical forms of white fever include psychotic states with the presence of a clinical picture of the disorders inherent in the endogenous process (schizophrenia). In these cases, the symptoms characteristic of white fever, co-exist with the symptoms of mental automatism or are accompanied by an infection of consciousness. Atypical white fever often occurs after repeated psychosis. Similar clinical forms are not isolated in ICD-10 in the form of outlined syndromes, in this case it is justified to classify such conditions as withdrawal syndrome with delirium of another (F10.48 *).

White fever with fantastic content (fantastic delirium, alcoholic onyeroid, delirium onyroid)

In the prodromal period, multiple photopsy, acoasms, elementary visual hallucinations, episodes of figurative delirium prevail. The development of alcoholic onyroids occurs according to the type of complication of the clinical picture. Psychosis can begin as a fantastic hypnagogic or classic delirium. In the daytime, visual, verbal hallucinations, imaginative delirium, delusional disorientation can occur. Characteristic lyutsiyadnye gaps. On the 2nd-2nd day, as a rule, at night, the clinical picture becomes more complicated: stsenopodobnye visual and verbal hallucinations, observe delusional frustration of fantastic content, multiple false recognitions, motor excitement from complex coordinated actions goes to random, chaotic.

The content of the hallucinations tested is more often of a fantastic nature, it is noted by frightening visions - wars, catastrophes, travel to exotic countries. In the minds of the patients, weirdly intertwine, without any definite sequence, the events of everyday and adventure-fantastic content. Hallucinatory pictures are usually sketchy, incomplete. Another interesting observation: with open eyes the patient is a spectator, with closed ones - a participant in the events that occur. In this case, patients always have a sense of rapid movement in space.

With the prevalence in the clinical picture of scenic-like visual hallucinations, general drowsiness and immobility increase; the condition resembles a sub-stump or stupor. Tom, however, being in a state of inhibition, the patient answers questions, but only after repeated repetitions, monosyllables. As with other types of delirium, the autopsychic orientation is preserved, the orientation in place and time is false. Often observe a double orientation - the coexistence of correct and false representations. The mimicry of the patient resembles that of an onyroid - the frozen face turns into frightened, anxious, surprised. In the initial stages of psychosis, the affect of fear predominates. With further complication of the clinical picture, fear disappears, giving way to curiosity, surprise, close to complacency. Periodically, the patient tries to go somewhere, but with persuasion or insignificant coercion calms down. Negativism is absent.

The duration of psychosis is from several days to a week, the output is critical, after a deep long sleep. Painful memories persist long enough, the patient tells about them in detail even after a long time. After psychosis in some cases there is residual nonsense.

[1], [2]

White fever with onyric disorders (alcoholism)

For white fever with onyric disorders characterized by a small depth of confusion of consciousness, a much less pronounced illusory-delusional component compared with the oneiroid delirium. From the very beginning, hallucinations have a vivid character. According to the data of different authors, there is no pseudo-hallucination of ordinary content under onyricism, mental automatisms are not expressed. Psychosis ends critically, after a deep sleep, on the 6th-7th day from its beginning.

White fever with mental automatisms

Mental automatisms arise in the complication of a typical or at the height of systematized delirium, when a combination of delirium with expressed verbal hallucinations or with onyroid states. Mental automatisms are transient, incomplete, almost all of their variants are observed - ideal, sensory, motor. More often, automatisms arise in an isolated form, sometimes there are combinations of them (ideator with touch or motor with touch); However, in the opinion of many authors, they never meet simultaneously three kinds of automatisms. At reduction, the delirium of automatism disappears first. The duration of psychosis varies up to 1.5-2 weeks. The yield is critical, with the lithic variant, the formation of residual delusion is possible.

Differential diagnosis of white fever

It is necessary to carry out differential diagnostics of alcoholic delirium and delirious disorders caused by acute intoxication with preparations with cholinolytic effect (atropine, dimedrol, etc.), stimulants (cocaine, zfedrin, etc.), volatile organic substances, infectious disease, surgical pathology (acute pancreatitis , peritonitis), febrile condition of different genesis.

Differential diagnosis of alcoholic and intoxicating fever

	White fever in alcohol dependence	White fever in intoxication
Anamnesis	Prolonged systematic abuse of alcohol, signs of alcohol dependence	Epidemiological history Data on the extension of an infectious disease Surgical pathology Substance abuse (stimulants, volatile organic substances, anticholinergics)
Clinical data	Absence of signs: acute intoxication with psychoactive substances; an infectious disease; surgical pathology; fevers	Signs of intoxication with psychoactive substances Infectious disease Acute surgical pathology High temperature
Laboratory data	Signs of alcoholic liver damage (increased levels of liver enzymes), chronic intoxication (increased ESR, relative leukocytosis)	Determination of psychoactive substances in biological environments Identification of an infectious agent Signs of surgical pathology (eg, high levels of amylase in acute pancreatitis)

If there are problems with the diagnosis of delirious condition, an infectious disease specialist, a surgeon, may be needed.

[3], [4], [5], [6], [7], [8], [9], [10]

Treatment of white fever and alcoholic encephalopathies (F10.40 *)

Modern tactics of treatment of white fever, regardless of the degree of its severity, is aimed at reducing the intoxication of the body, maintaining vital functions or preventing their disorders. Even with the development of early signs of delirium, plasmapheresis is prescribed with the removal of 20-30% of the volume of circulating plasma. Then the infusion therapy is performed. Such a tactic makes it possible to greatly facilitate the course of psychosis, and in some cases to prevent its further development. The method of choosing detoxification therapy for typical white fever is forced diuresis: massive infusions of solutions in the volume of 40-50 mg / kg under the control of central venous pressure, electrolyte balance, acid-base blood state, blood plasma glucose and diuresis; if necessary, prescribe diuretics, insulin. In the framework of detoxification therapy, enterosorbents are also used.

It is necessary to replenish electrolyte losses, carry out correction of acid-base state. Especially dangerous is the loss of potassium, as this can cause tachyarrhythmias and cardiac arrest. With potassium deficiency and metabolic alkalosis, 1% potassium chloride solution is administered intravenously slowly, no more than 150 ml / day. If the kidney function is impaired, potassium preparations are contraindicated in each clinical situation, the doses are set depending on the indications of the water-electrolyte balance and the acid-base state. The elimination of metabolic acidosis is followed by buffer solutions containing so-called metabolizable anions of organic acids (acetate, citrate, malate, gluconate), for example, sterofundin, acesol and other solutions intravenously slowly under the control of acid-base balance.

In solutions for intravenous infusion, add large doses of vitamins (thiamine - up to 1 g / day, pyridoxine, ascorbic and nicotinic acid).

Assign drugs that enhance metabolism (1.5% solution of meglumine sodium succinate 400-800 ml intravenously drip 4-4.5 ml / min for 2-3 days or cytoflavin 20 40 ml in 200-400 ml 5% glucose solution intravenously drip 4- 4.5 ml / min for 2-3 days).

Cytoflavin is the first complex neurometabolic drug developed on the basis of modern knowledge and discoveries in the field of molecular biology of cellular respiration and clinical medicine.

Cytoflavin is a harmonious neuroprotective composition that contributes to the safe and rapid withdrawal from abstinence.

After the first day of treatment, there is a disappearance of headache, sweating, weakness, irritability. After the course of therapy, sleep is normalized, affective disorders are reduced. Cytoflavin is well tolerated and safe.

• Composition: in 1 ml of the preparation: succinic acid - 100 mg, nicotinamide - 10 mg, riboxin - 20 mg, riboflavin - 2 mg.
• Indication: toxic (including alcoholic) encephalopathy, alcohol withdrawal syndrome.
• Contraindications: individual intolerance to the components of the drug.
• Dosing and Administration: 10 ml of the solution intravenously drip in the dilution for 200 ml of glucose 2 times a day for 5 days.
• Packing: ampoules with solution for injections No. 10, No. 5.

Means that improve the rheological properties of the blood (dextran (reopolyglucin) 200-400 ml / day), cerebral circulation (a solution of instenon 2 ml 1-2 times a day or 2% solution of pentoxifylline 5 ml in a 5% solution of glucose 1- 2 times a day.) Nootropic drugs are used that do not excite the central nervous system (semax - 0.1% solution of 2-4 drops and nose twice a day or gopanthenic acid (pantogam), 0.5 g 3 times a day), and hepatoprefectors | ademethionine (heptral) 400 mg 1-2 times a day, tioktovuyu acid (espa-lipon) to 600 mg once a day |. Also shown are medicines and measures aimed at preventing hypoxia and cerebral edema: 10% solution of meldonia (mildronate) 10 ml 1 time per day or 5% mexidol 2 ml 2 3 times a day. 25% magnesium sulfate solution 10 ml 2 times a day, oxygen therapy, hyperbaric oxygenation, cranial hypothermia, etc. Careful monitoring of the vital functions of the patient (breathing, cardiac activity, diuresis) and timely symptomatic therapy aimed at their maintenance (for example, the appointment of cardiac glycosides for heart failure, analeptics for breathing disorders, etc.). A specific choice of drugs and solutions for infusion, drug and non-drug therapy should be built taking into account the violations in each specific case.

Treatment of white fever and acute encephalopathy

States	Recommended treatment
Proderimal, prodromal period of acute alcoholic encephalopathy	Treatment aimed at reducing intoxication, correction of electrolyte disorders and improvement of rheological properties of blood: plasmapheresis (20-30% of the volume of circulating plasma); Povidone 5 g 3 times a day inward in dilution with water; sterolundin isotonic 500 ml, or disulant 400 ml; 1% solution of caline chloride 100-150 ml, intravenously drip (with hypokalemia, adequate diuresis); dextran reopolyglucin) 200-400 ml intravenously drip
	Treatment aimed at arresting psychomotor agitation, sleep disorders: a 0.5% solution of diazepam for 2-4 ml intramuscularly or intravenously drip to 0.08 g / day; 0.1% solution of phenazepam in 1-4 ml intramuscularly and intravenously drip to 0.01 g / day
	Vitaminotherapy: 5% solution of thiamine (vitamin B1) 4 ml intramuscularly; 5% solution of pyridoxine (vitamin B6) 4 ml intramuscularly; 1% solution of nicotinic acid (vitamin PP) 2 ml intramuscularly; 5% solution of ascorbic acid (vitamin C) 5 ml intravenously; 0,01% solution of cyanocobalamin (vitamin B12) 2 ml intramuscularly.
	Neurometabolic therapy: Semax - 0.1% solution of 2-4 drops in the nose 2 times a day or gopantenic acid in 0.5 g 3 times a day
	Hepatoprotectors: ademetionin 400 mg T-2 times a day; Thioctic acid (espa-lipone) to 600 mg 1 time per day
Unfolded white fever, acute alcoholic encephalopathy	Fixation of the patient
	Infusion therapy in the volume of 40-50 ml / kg under the control of central venous pressure, electrolyte balance, acid-base balance of blood, blood plasma glucose and diuresis, if necessary, appoint diuretics, insulin Apply 1.5% solution of meglumine sodium succinate (reamberin) 400 -500 ml intravenously drip at a rate of 4-4.5 ml / min 2-3 days or cytoflavin for 20-40 ml in 200-400 ml of 5% glucose solution intravenously drip at a rate of 4-4.5 ml / min 2-3 day, dextran (reopolyglucin) 200-400 ml / day, sterofundin, acesol \ disol
	Prevention of hypoxia and edema of the brain; 10% solution mephedonia 10 ml 1 time per day or 5% solution mexidol 2 ml 2-3 times a day, 25% solution of magnesium sulfate 10 ml 2 times a day
	With non-curable excitation, convulsive conditions - short-acting barbiturates (sodium thiopental, texobarbital (hexenal) up to 1 g / day intravenously drip under the constant control of respiration and circulation)
	Oxygenotherapy or hyperbaric oxygen therapy
	Symptomatic baking of somatic complications
Heavy forms of white fever, encephalopathy Gaye-Wernicke.	Monitoring of vital functions (breathing, heartbeat, diuresis), regular monitoring, kispogio-alkaline balance, determination of potassium, sodium, glucose levels in blood plasma
	Balanced Infusion Therapy
	Cranial hypothermia
	Nootropic drugs: pyracetam 5-20 ml of 20% solution intravenously, cortexin 10 mg intramuscularly in 1 ml of 0.9% sodium chloride solution
	Vitaminotherapy
	Course of hyperbaric oxygenation
	Symptomatic treatment of somatic complications

It should be noted that, with a white fever, the antipsychotic activity of existing psychotropic drugs has not been proven. They are prescribed for psychomotor agitation, expressed anxiety and insomnia, and also if there is an anamnesis of convulsive seizures. Drugs of choice benzodiazepine series 0.5% solution of diazepam (Relanium) 2-4 ml intramuscularly or intravenously drip to 0.06 g / day; 0.1% solution of phenazepam 1-4 ml intramuscularly or intravenously drip to 0.01 g / day and short-acting barbiturates thiopental sodium, hexobarbital (hexenal) up to 1 g / day intravenously drip under the constant control of respiration and circulation. In severe white fever (professional, mussifying) and acute alcoholic encephalopathy, the introduction of psychotropic drugs is contraindicated.