CME Journal of Clinical Case Reports
ISSN: 3067-7998 | DOI: 10.64030/3067-7998
Inder Preet Singh Bhatia, Hitesh Sinduriyan, Sanjay Singh Rawal and Raj Narayan Mandal
Acute pancreatitis is an acute inflammatory process of the pancreas that can initiate a systemic inflammatory response syndrome resulting in acute respiratory distress syndrome and multi-organ dysfunction. Alcohol is one of the common etiology of acute pancreatitis. Sudden cessation of alcohol consumption can result in acute alcohol withdrawal, and a few subsets of these patients can develop severe forms of withdrawal like delirium tremens. Cardiac arrhythmias like ventricular tachycardia, further increase risk of mortality in these patients. Severe acute pancreatitis, delirium tremens, and ventricular tachycardia manifesting all together in a single patient are rare and poses therapeutic challenge.
Case Description: Here, we report a 36-year-old male who presented to the non-cardiac centre, a case of severe acute pancreatitis (alcohol-related) who developed delirium tremens on day 4 of admission and Ventricular tachycardia on day 5. He was managed with benzodiazepines, amiodarone infusion and synchronised cardioversion. Sinus rhythm was achieved after 6 hours of amiodarone infusion. Amiodarone infusion was continued for 48 hours, followed by maintenance doses. He again had Sustained Ventricular tachycardia. Restarted on amiodarone infusion along with lignocaine infusion. Rhythm was restored to Sinus rhythm after 03 hours. Benzodiazepines were discontinued on day 16 of admission after gradual tapering. His course in the hospital was complicated by respiratory distress requiring intubation, increased peripancreatic collection, which was managed with pigtail drainage. Pigtail was removed after 4 weeks of drainage. He was discharged after 12 weeks of in hospital management. Conclusion: This case highlights the importance of an aggressive approach in the management of ventricular tachycardia, as a severe complication of delirium tremens. Clinicians should maintain a high index of suspicion for cardiac complications in patients with severe acute pancreatitis and alcohol withdrawal, as timely diagnosis and management can be lifesaving.