Annotation. Today, the number of benzodiazepine-resistant alcoholic deliriums is growing. It is actually to search for an optimal scheme of sedation with a combination of two sedatives. The aim of the study was to compare efficacy of standard sedation with added barbiturates and the schemes with using ketamine and sodium oxybutyrate. We tested 60 cases of delirium tremens which were randomized into three groups. In the control group we conducted the traditional sedation with added sodium thiopental. In the first research group we combined the infusion of ketamine with diazepam. In the second one we gave sodium oxybutyrate with diazepam. We evaluated the duration of delirium, hemodynamics parameters, serum cortisol and serotonin, laboratory indicators of kidneys and liver condition. We used such statistical methods as Mann-Whitney test, Wilcoxon T-criterion and Kruskal-Wallis H-criterion. The duration of delirium was significantly lower in research groups in comparison with the control one. There was no difference of the duration of delirium between research groups. It indicates a comparable effect of using either ketamine, or sodium oxybutyrate. All groups showed significant reduction of hemodynamics parameters in the process of the treatment, however we observed more cases of hypertension and tachycardia on the third day of the treatment in the research groups than in the control one. These data suggest an insufficient effect of the combination of diazepam with both ketamine and sodium oxybutyrate on the sympatho-adrenal system. Serum cortisol was significantly reduced in all the groups, there was no difference between control and research groups. Serotonin was equally increased in all the groups on the third day. The obtained results indicate that the effectiveness of the combination of benzodiazepines with both ketamine and sodium oxybutyrate is comparable to the standard sedation regimen and does not differ in the reaction of these biomarkers. The laboratory indicators of kidneys condition on the third day increased only in the research groups, which indicates more negative influence on kidneys by both ketamine and sodium oxybutyrate. The indicators of liver condition were significantly reduced only in the group of ketamine, there were no difference in the rest groups. The use of ketamine and sodium oxybutyrate as adjuvant sedation may reduce the duration of a delirium episode, but has insufficient effect on hemodynamics and may adversely affect renal function.

Annotation. Alcohol addiction is one of the three main health problems in the world, which directly or indirectly increases the mortality rate, wherein it poses the greatest threat to the developed countries of Europe and America. Identification of promising directions for resolving the issue of alcohol withdrawal syndrome with delirium is one of the levers to reduce the consequences of its harmful use. It was made an analysis of the electronic database of scientific publications Pubmed and the latest WHO data, the main approaches to the pathogenesis and intensive care of alcoholic delirium in Ukraine and abroad were highlighted and displayed, clinical and laboratory diagnostic aspects were distinguished. There is a certain vision of the pathogenesis of alcohol withdrawal syndrome as an imbalance in the GABA and glutamate-ergic systems in brain neurons. Diagnostic criteria have been developed and introduced into clinical practice to determine the severity of withdrawal status, as well as sedation-agitation scales, it is not completely determined the influence of electrolyte disturbances, namely magnesium deficiency on the severity of the condition, the effectiveness of sedation and mortality. The optimal way to increase the effectiveness of the treatment of alcoholic delirium, which would ensure an adequate level of sedation, has not yet been found all over the world, at the same time, without increasing the risk of complications in the form of an overdose of tranquilizers and hypnotics, both in case of their isolated and combined use. The possibility of using chelate compounds containing GABA in themselves, as well as organic magnesium salts, namely gluconic acid salts, is promising.

Chronic alcoholism is one of the factors of early mortality in the world. The most formidable complication of this addiction is the state of alcohol withdrawal with delirium. It is based on a long-term imbalance of the GABA and glutamatergic systems in the brain. Today, the search for an optimal sedation regimen that would be effective on the one hand, and, on the other hand, would have a sufficient safety profile, remains relevant. Three sedation regimens with the addition of ketamine, sodium oxybutyrate and dexmedetomidine were investigated. All were compared with the traditional sedation (control) regimen and with each other. The control points of the study were the following parameters: the duration of the episode of delirium, hemodynamics, plasma cortisol and serotonin, laboratory parameters of the state of the kidneys and liver. As a result of the study, we found that all of the proposed schemes had a shorter duration of delirium compared to the control. The shortest episodes of delirium were observed in the dexmedetomidine group. None of the proposed groups could adequately normalize hemodynamic parameters. We believe that the reason for this is both the peculiarities of the mechanism of action of the drugs we have chosen, and electrolyte imbalance, in particular, hypomagnesemia. The safety of our proposed sedation regimens requires further comprehensive research

Background. The role of magnesium in the treatment of alcohol withdrawal with delirium is indefinite, although it is well known about its participation in the pathogenesis of this severe condition. The study was aimed to reveal the benefits and disadvantages of the sedation with added magnesium sulfate in comparison with traditional sedative therapy. Materials and methods. In our study, we tested 40 treated patients, which were randomized in two groups. We controlled the level of sedation by the Richmond agitation-sedation scale. The target level of sedation was between 0 and –2 points. We maintained this level in all the patients. In all groups, we evaluated the following values: duration of delirium, mean arterial pressure, pulse, the level of serum magnesium, cortisol and serotonin, laboratory indicators of kidneys, and liver condition. In the control group, we carried out the sedation with 10–20 mg of diazepam every 4–6 hours with infusion of barbiturates as needed. The treatment in the research group was identical with addition of magnesium sulfate 50 mg/kg every 8 hours. Results. The results of the study demonstrated that the duration of delirium is significantly lower in the research group in comparison with the control (p < 0.05). We found hypomagnesemia in almost half of the patients. The indicators of haemodynamics such as mean arterial pressure and pulse were significantly lower in both groups on the third day (p < 0.05). We found 4 cases (20 %) of hypotension in the research group and 2 cases (10 %) in the control group. The study of the dynamics of serum cortisol and serotonin showed the significant difference on the third day in both groups (p < 0.05). We found no difference in these laboratory parameters on the third day between groups (p ≥ 0.05). There was no significant difference between the laboratory indicators of kidneys and liver condition in both groups (p ≥ 0.05). Conclusions. The use of magnesium sulfate allowed decreasing the duration of delirium but had an excessive effect on haemodynamics. Such biomarkers as serum cortisol and serotonin didn’t verify the effect of magnesium sulfate.