Delirium Tremens

Medically Reviewed by Jennifer Casarella, MD on September 03, 2022
3 min read

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.

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

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.

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
  • MRI to look for signs of seizures or head injury
  • 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 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 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.