Delirium Tremens Symptoms, Causes and Treatment

Delirium tremens is a life-threatening withdrawal syndrome that may affect people with severe, chronic alcoholism. Often referred to as the DTs, the condition is characterized by hallucinations, disorientation, anxiety and uncontrollable shaking. People at risk should detox in rehab facility.
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Withdrawing from alcohol can be an uncomfortable and, in some cases, excruciating process. As soon as six hours after someone who is dependent on alcohol takes their last drink, they may begin to experience anxiety, tremors, headache, sweating, nausea and other distressing alcohol withdrawal symptoms.

For some people with an alcohol addiction, withdrawal symptoms are relatively mild. But between 5 and 10 percent of people withdrawing from alcohol go on to develop a severe form of withdrawal known as delirium tremens (DTs), which can be life-threatening.

Symptoms of Delirium Tremens

Delirium tremens usually sets in about three days after other alcohol withdrawal symptoms begin, according to the New England Journal of Medicine, and can last anywhere from one to eight days, though two to three days is typical. DTs have been known to occur as late as a week to 10 days after someone quits drinking.

Symptoms typically include extreme hyperactivity or restlessness, sudden bursts of energy, vivid hallucinations, mental confusion and disorientation, and psychosis.

Individuals with heavy, long-term alcohol use are more prone to develop delirium tremens.

Other symptoms of delirium tremens include agitation and irritability, a deep sleep that can last for a day or more, fear or excitement, quick mood changes, fever and sensitivity to light, touch and sound. Grand mal seizures, which are convulsions that involve the entire body, usually occur within 12 to 48 hours after the last drink.

Delirium tremens is considered a medical emergency.

During the early 20th century, nearly 40 percent of those suffering from delirium tremens died. Today, between five and 25 percent of those who develop DTs typically die — usually as a result of a very high body temperature, heart rhythm abnormalities, seizure-related complications and other related medical disorders.

Risk Factors for Delirium Tremens

While it’s impossible to know who will or won’t develop delirium tremens while detoxing from alcohol, there are a number of factors that can increase the chances someone will develop the DTs.

Individuals with heavy, long-term alcohol use are more prone to develop delirium tremens. Most at risk are those who drink two to three bottles of wine per day, seven or eight pints of beer or a pint of hard liquor every day. Those who’ve suffered from alcoholism for 10 years or longer are also at higher risk — as are those over the age of 40.

People who’ve suffered from delirium tremens previously have a 6 percent higher risk of developing DTs again, and a history of previous withdrawal seizures increases someone’s chances of experiencing the DTs by almost 7 percent. Patients with other illnesses are also at a higher risk of developing DTs.

Autonomic nervous system overactivity — which can manifest as elevated heart rate, sweating, fever, anxiety and confusion — can also boost one’s risk of DTs. For this reason, people in withdrawal should be watched closely if they have a systolic blood pressure exceeding 150 mm Hg or their heart rates exceed 100 beats per minute.

Studies suggest that patients with low potassium levels, lower blood platelet counts and the presence of structural brain lesions are also more likely to develop DTs.

Treatment for Delirium Tremens

Because of the high fatality rate, treatment for delirium tremens is best carried out in a “locked inpatient ward” or ICU, according to the New England Journal of Medicine. Treatment is usually focused on controlling agitation, promoting sleep and decreasing the risk of seizures.

Patients are typically hospitalized in a quiet, well-lit room, where their vital signs are frequently monitored. Nursing staff keeps a close eye on the individual’s electrolyte levels and hydration status. Because a person in the throes of delirium tremens may lose touch with reality, nurses continuously reorient the patient, reminding them of where they are and what’s happening.

An individual suffering from DTs also receives medications through an intravenous line. Typical therapy includes infusions of thiamine (vitamin B1) twice a day. This prevents Wernicke-Korsakoff syndrome, a sometimes fatal brain disorder caused by thiamine deficiency.

Intravenous sedatives such as valium are administered frequently to keep the patient calm and prevent seizures. Some patients may also require antipsychotic medications, such as haloperidol, to prevent hallucinations and severe agitation. Another important aspect of care is in preventing other medical complications, including aspiration pneumonia, which develops in nearly one-third of patients with DTs.

While most people withdrawing from alcohol don’t develop delirium tremens, the condition is dangerous enough that it necessitates medical intervention. That’s why it’s so important that individuals who want to quit drinking consult with a physician or addiction specialist before they stop. Your doctor can conduct an assessment to determine if going through alcohol detox at home is a safe option for you. Some people require medically monitored detox followed by a stay at an inpatient facility for alcohol rehab.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
Medical Reviewer
Ashraf Ali
Psychiatrist, Los Angeles County Department of Mental Health

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