What is the definition of Delirium Tremens?

Delirium tremens is a severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.

What are the alternative names for Delirium Tremens?

Alcohol abuse - delirium tremens; DTs; Alcohol withdrawal - delirium tremens; Alcohol withdrawal delirium

What are the causes for Delirium Tremens?

Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food.

Delirium tremens may also be caused by head injury, infection, or illness in people with a history of heavy alcohol use.

It occurs most often in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints (1.8 to 2.4 liters) of wine, 7 to 8 pints (3.3 to 3.8 liters) of beer, or 1 pint (1/2 liter) of "hard" alcohol every day for several months. Delirium tremens also commonly affects people who have used alcohol for more than 10 years.

What are the symptoms for Delirium Tremens?

Symptoms most often occur within 48 to 96 hours after the last drink. But, they may occur 7 to 10 days after the last drink.

Symptoms may get worse quickly, and can include:

  • Delirium, which is sudden severe confusion
  • Body tremors
  • Changes in mental function
  • Agitation, irritability
  • Deep sleep that lasts for a day or longer
  • Excitement or fear
  • Hallucinations (seeing or feeling things that are not really there)
  • Bursts of energy
  • Quick mood changes
  • Restlessness
  • Sensitivity to light, sound, touch
  • Stupor, sleepiness, fatigue

Seizures (may occur without other symptoms of DTs):

  • Most common in the first 12 to 48 hours after the last drink
  • Most common in people with past complications from alcohol withdrawal
  • Usually generalized tonic-clonic seizures

Symptoms of alcohol withdrawal, including:

  • Anxiety, depression
  • Fatigue
  • Headache
  • Insomnia (difficulty falling and staying asleep)
  • Irritability or excitability
  • Loss of appetite
  • Nausea, vomiting
  • Nervousness, jumpiness, shakiness, palpitations (sensation of feeling the heart beat)
  • Pale skin
  • Rapid emotional changes
  • Sweating, especially on the palms of the hands or the face

Other symptoms that may occur:

  • Chest pain
  • Fever
  • Stomach pain

What are the current treatments for Delirium Tremens?

The goals of treatment are to:

  • Save the person's life
  • Relieve symptoms
  • Prevent complications

A hospital stay is needed. The health care team will regularly check:

  • Blood chemistry results, such as electrolyte levels
  • Body fluid levels
  • Vital signs (temperature, pulse, breathing rate, blood pressure)

While in the hospital, the person will receive medicines to:

  • Stay calm and relaxed (sedated) until the DTs are finished
  • Treat seizures, anxiety, or tremors
  • Treat mental disorders, if any

Long-term preventive treatment should begin after the person recovers from DT symptoms. This may involve:

  • A "drying out" period, in which no alcohol is allowed
  • Total and lifelong avoidance of alcohol (abstinence)
  • Counseling
  • Going to support groups (such as Alcoholics Anonymous)

Treatment may be needed for other medical problems that can occur with alcohol use, including:

  • Alcoholic cardiomyopathy
  • Alcoholic liver disease
  • Alcoholic neuropathy
  • Wernicke-Korsakoff syndrome

What are the support groups for Delirium Tremens?

Attending a support group regularly is a key to recovering from alcohol use.

What is the outlook (prognosis) for Delirium Tremens?

Delirium tremens is serious and may be life threatening. Some symptoms related to alcohol withdrawal may last for a year or more, including:

  • Emotional mood swings
  • Feeling tired
  • Sleeplessness

What are the possible complications for Delirium Tremens?

Complications can include:

  • Injury from falls during seizures
  • Injury to self or others caused by mental state (confusion/delirium)
  • Irregular heartbeat, may be life threatening
  • Seizures

When should I contact a medical professional for Delirium Tremens?

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms. Delirium tremens is an emergency condition.

If you go to the hospital for another reason, tell the providers if you've been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.

How do I prevent Delirium Tremens?

Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.

REFERENCES

Kelly JF, Renner JA. Alcohol-related disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 26.

Mirijello A, D'Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-365. PMID: 25666543 www.ncbi.nlm.nih.gov/pubmed/25666543.

O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.

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