Expert: Ronald Levy, M.D. - 10/22/2010

Question
Dr. Levy,

My question is similar to one asked before, but it has some really wicked turns.  My 44 year old wife was abusing alcohol and possible Xanex pills without my knowledge. She fell breaking her ankle or in medical terms a trimalleolar fracture.  While in the emergency room results from her toxicology indicated that her blood alcohol level was .264.  She had received 12mg of morphine, and 4mg of Zofran in a one hour period, then taken to surgery.  She was given a general anesthesia on top of the high BA.  I was not aware that her BA was that high prior to her surgery. She was given a morphine pump for pain management, which I understand you will not address.  However, within 36 hours of her surgery she was literally out of her mind.  She was hallucinating, jumping out of bed and running past staff on the recently repaired ankle, and after three days of this behavior she was moved to the Behavioral Health Unit.  She was never restrained, or prevented from getting out of bed.  Doctors claim she was suffering from DT's, and Wernicke's Korsakoff Syndrome due to low thiamine levels.  My question; would the morphine, and the endotracheal anesthesia coupled with the high blood alcohol level expedite or contribute to her severe hallucinations and psychosis for eight days?  Her CIWA scores were off the chart.

Answer
It does sound like DTs. I am pretty sure the anesthesiologist would have given either Versed or Valium as part of the anesthetic (which would have actually helped prevent her DTs). I am surprised that these were not continued after surgery. The typical cocktail includes Valium, Thiamine and various vitamins. The Morphine is not going to worsen that and certainly the anesthesia isn't either.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston