Delirium Tremens

What Is Delirium Tremens?

Delirium tremens, also called DTs or alcohol withdrawal delirium (AWD), 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 attackstroke, and death.

Delirium Tremens Causes and Risk Factors

Alcohol is a depressant. It slows your brain and nervous system.  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 an amino acid called glutamate that causes some symptoms common in delirium tremens, like sudden, extreme high blood pressure, tremors, severe excitability, and seizures.

Delirium tremens is most common among:

  • Adult men, especially white, younger, unmarried men
  • People with a history of seizures
  • Those who have gone through alcohol withdrawal before
  • Heavy and long-term drinkers

For women, eight or more drinks per week is "heavy drinking." For men, it's 15 a week.

What is a drink? The standards are:

  • 12 ounces of beer
  • 7 ounces of malt liquor
  • 5 ounces of wine
  • 1.5 ounces of 80-proof liquor or distilled spirts, like vodka, rum, or whiskey

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Delirium Tremens Symptoms

Usually, you'll start having symptoms 2 to 4 days after your last drink, But some symptoms may not show up until up to 10 days after you give up alcohol.

They can include:

  • Tremors or shaking hands and feet
  • Chest pain
  • Confusion
  • Deep sleep that lasts for a day or longer
  • Dehydration
  • Excitability or anger
  • Fever
  • Getting startled more easily
  • Hallucinations
  • Heavy sweating
  • High blood pressure
  • Nausea or vomiting
  • Nightmares
  • Other tremors, including muscle tremors
  • Pale skin
  • Passing out
  • Problems with eye muscle and movement
  • Rapid heartbeat
  • Seizures
  • Sensitivity to light, sound, and touch
  • Severe hyperactivity
  • Sleepiness, stupor, or fatigue

Delirium tremens can cause your body temperature, breathing, or blood circulation to change quickly. This could lead to life-threatening complications like sepsisirregular heartbeattrouble 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.

Delirium Tremens Diagnosis

Your doctor will start with a physical exam and medical history. They may also give you -- or a 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 magnesium level
  • Blood potassium level
  • Electroencephalogram (EEG) to test brain activity
  • Lumbar puncture test to examine spinal cord fluid
  • Metabolic panel
  • Toxicology screen (blood or urine)

Doctors may also check your liverheart, 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

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.

Read more: Alcohol treatment for veterans.

WebMD Medical Reference Reviewed by Jennifer Casarella on July 13, 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?”

Amethyst Recovery Center: "Alcohol Detox & Withdrawal: Symptoms & Treatment."

University of Florida Health: "Delirium tremens."

CDC: "Alcohol Use and Your Health."

St. Luke's Hospital: “Delirium Tremens.”

National Institutes of Health: "Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders."

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