Delirium tremens, also called DTs or withdrawal delirium, is a severe type of withdrawal from alcohol. It usually starts about 2 to 3 days after someone who’s dependent on alcohol ends a long drinking binge.
DTs usually lasts for 2 to 3 days, but symptoms may linger for as long as a week.
What Causes Delirium Tremens?
When you suddenly stop drinking after a long period of alcohol use, your brain and nervous system can’t adjust quickly. Your brain gets overstimulated. People with alcohol use disorder who suddenly stop drinking may also have a spike in a protein called glutamate that causes symptoms like sudden, extreme high blood pressure, tremors, and severe excitability and possibly seizures.
Who’s Most at Risk for DTs?
Delirium tremens is most common among adult men, especially white, younger, unmarried men.
People who’ve had DTs before, who have a history of seizures, or have gone through alcohol withdrawal in the past are also at higher risk.
Delirium Tremens Symptoms
DTs can cause sudden symptoms like:
- Excitability or anger
- Severe hyperactivity
- Rapid heartbeat
- Heavy sweating
- High blood pressure
- Passing out
- Tremors or shaking hands and feet
- Nausea or vomiting
Delirium tremens can cause your body temperature, breathing, or blood circulation to change quickly. This could lead to life-threatening complications like sepsis, irregular heartbeat, trouble breathing, seizures, or an electrolyte imbalance -- when the minerals that control your body’s functions are out of whack.
Someone with delirium tremens needs immediate treatment in a hospital. Call 911 if you or someone you know has symptoms.
Diagnosis and Treatment
Your doctor will start with a physical exam and medical history. They may also give you -- or caregiver or loved one who’s with you -- a questionnaire called a Clinical Institute Withdrawal Assessment. This can help them determine your symptoms and measure the severity of your withdrawal. A score of 15 or higher means you’re at high risk for delirium tremens.
Other tests that your doctor might do include:
- Blood tests
- Electroencephalogram (EEG) to test brain activity
- MRI to look for signs of seizures or head injury
- Lumbar puncture test to examine spinal cord fluid
Doctors may also check your liver, heart, the nerves in your feet, and your digestive system to figure out the level of alcohol damage to your body. You may also be low on vitamins because of an unhealthy diet.
Delirium tremens treatment begins at the hospital. Benzodiazepines are the most commonly used medications for alcohol withdrawal and DTs. They help calm your excited nervous system. You may also need intravenous fluids with vitamins and minerals to treat dehydration or bring your electrolytes back into balance.
Other drugs used in the hospital to treat acute DTs symptoms include:
- Antipsychotic drugs to help calm you down and to prevent hallucinations
- Blood pressure medications
- Drugs to regulate your heartbeat
- Pain medication
You may need to stay in the hospital for up to a week to stabilize your health. After that, you should get treatment for alcohol dependence. The government’s Substance Abuse and Mental Health Services Administration (SAMSHA) has an online treatment facility locator at findtreatment.samhsa.gov. Cognitive behavioral therapy (CBT) or recovery support groups may help you as they try to stay sober moving forward.