What Is Delirium Tremens?

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.

About 5% of people in alcohol withdrawal get DTs. If untreated, delirium tremens can cause a heart attack, stroke, or even death.

What Causes Delirium Tremens?

Alcohol is a depressant. It slows your brain and nervous system. Years of regular heavy drinking can change your brain chemistry.

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:

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.

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Other tests that your doctor might do include:

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:

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.

WebMD Medical Reference Reviewed by Jennifer Casarella on January 21, 2020

Sources

SOURCES:

American Addiction Centers: “Delirium Tremens: Symptoms and Treatment.”

New England Journal of Medicine: “Recognition and Management of Withdrawal Delirium (Delirium Tremens).

Alcohol.org: “Alcohol Withdrawal Symptoms and Timeline.”

StatPearls: “Delirium Tremens (DT).”

Harvard Medical School: “Alcohol Withdrawal: What Is It?”

Winchester Hospital: “Delirium Tremens.”

Roswell Park: “Electrolytes -- What Are They?”

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