Delirium tremens or DTs is the most severe form of alcohol withdrawal. Although rare, it can be potentially life-threatening.
This article discusses delirium tremens. You will learn:
- What causes alcohol withdrawal
- Symptoms of delirium tremens (DTs)
- Risk factors for DTs
- How DTs is treated
If you or someone you love are struggling with alcohol use disorder, please reach out to First Step Behavioral Health today to learn about your treatment options.
Understanding Alcohol Withdrawal
Alcohol affects how the nervous system works by altering its excitatory and inhibitory functions, which slows down brain activity and typically makes a person feel relaxed and less anxious. With prolonged and heavy alcohol use, the brain adjusts to these effects, leading to tolerance. This means that over time, more alcohol is needed to achieve the same effects.
As someone continues to drink, the brain adapts further. Eventually, dependence develops, and the brain becomes reliant on alcohol to maintain its balance. When alcohol use is suddenly stopped or significantly reduced, the brain, which has been compensating for the depressant effects of alcohol, now finds itself in a state of overactivity. This imbalance results in withdrawal symptoms, which include heightened arousal and various physical and psychological side effects.[1]
Common symptoms of alcohol withdrawal are:
- Anxiety
- Headaches
- Insomnia
- Tremors
- Shaking
- Fatigue
- Mood changes
- Nausea
- VOmiting
- Heart palpitations
- Increased blood pressure
- Increased heart rate
- Elevated body temperature
- Abnormal breathing
- Hallucinations
- Seizures
Alcohol withdrawal can be potentially life-threatening without medical treatment. Always seek treatment if you or someone you love suffers from alcohol addiction.
What are Delirium Tremens (DTs)?
Delirium tremens, known as DTs for short, is one of the most severe complications of alcohol withdrawal syndrome. It can occur after heavy, long-term drinking during alcohol withdrawal. Symptoms are different from alcohol withdrawal and include confusion, tremors, seizures, and delirium.
DTs do not happen to everyone. About half of people who abuse alcohol experience withdrawal if they stop drinking, but only 3-5% will suffer from DTs.[2]
Even though DTs are rare, the risk shouldn’t be underestimated. DTs can be life-threatening. The condition has an anticipated mortality rate of up to 37%.[2]
Symptoms
Delirium tremens symptoms progress from earlier alcohol withdrawal symptoms. Symptoms of delirium tremens include:[2,3]
- Agitation
- Aggression
- Irritability
- Confusion
- Trembling
- Sweating
- Rapid heartbeat
- Impaired consciousness
- Hallucinations (visual, tactile, and/or auditory)
- Tremors
- Seizures
Symptoms can change throughout the day, getting better or worse unexpectedly.
Timeline
Symptoms of DTs can fluctuate, however, a typical timeline is as follows:
- 6-24 hours after the last drink – Symptoms of alcohol withdrawal appear
- 12-48 hours after the last drink – Severe symptoms, such as seizures or hallucinations, will develop during this time. They may evolve into DTs.
- 3-5 days – DTs can continue for 3-4 days. Most people’s symptoms resolve after about 5 days. In extreme cases, symptoms can last up to 10 days.
Risk Factors
Certain risk factors can increase the potential for experiencing DTs during alcohol withdrawal. These include:[3,4]
- Drinking large amounts of alcohol in the weeks prior to withdrawal
- Having previous experience with severe alcohol withdrawal symptoms, such as DTs or withdrawal seizures
- The number of previous episodes of alcohol withdrawal
- Underlying health issues, such as major injuries, liver or heart disease, or traumatic brain injury
- Being of older age
- Having a psychiatric disorder
- Taking other drugs, medications, or supplements
- Being in poor general health, particularly lacking a well-balanced diet
The more risk factors a person has, the more severe their symptoms are likely to become.
Is Delirium Tremens an Emergency?
Yes, delirium tremens is a serious medical condition that is considered an emergency.
DTs require immediate medical attention because it can be life-threatening. The condition can lead to dangerous complications such as cardiac arrhythmias, electrolyte imbalances, dehydration, and respiratory issues. Medical intervention is crucial to stabilize the individual, manage symptoms, prevent complications, and provide necessary support through medications and medical supervision in a hospital setting.
Early Intervention is Key
The best way to prevent delirium tremens is to avoid drinking alcohol. If you must drink, be sure to follow the U.S. dietary guidelines which suggest limiting your alcohol intake to one drink per day if you are a woman and two drinks per day if you are a man. Consuming alcohol in greater quantities than this can be harmful to your health and increase your risk of alcohol use disorder.
Reducing alcohol intake slowly can help prevent DTs, but people with alcohol use disorder often struggle to control their drinking. As a result, it’s always best to seek professional help.
If you suffer from alcohol use disorder or experience withdrawal symptoms when you stop drinking, it’s essential to seek prompt medical treatment. Healthcare providers can provide safe management of withdrawal and 24-hour supervision.
How are Delirium Tremens Managed?
If you are at risk of experiencing alcohol withdrawal, it is crucial that you seek medical attention before detoxing. Delirium tremens is considered a medical emergency, but it can be prevented if you have support ahead of time.
For people at risk of DTs, inpatient detoxification is required. Medical professionals can prescribe medications and provide around-the-clock monitoring to ensure your comfort and safety. Severe cases of DTs may be transferred to the intensive care unit (ICU) for more intensive care.
Some of the medications that may be used to treat DTs are:[3,5]
- Benzodiazepines like lorazepam (Ativan), diazepam (Valium), or chlordiazepoxide (Librium) are commonly used to treat alcohol withdrawal symptoms, including delirium tremens and the risk of seizures. Higher doses may be needed for effectiveness.
- Barbiturates like phenobarbital are sometimes used in addition to benzodiazepines when benzodiazepines alone are not sufficient in managing symptoms.
- Antipsychotics like haloperidol (Haldol) may be prescribed in small amounts to reduce agitation, treat psychotic symptoms such as hallucinations, and improve mental clarity.
Patients may also be given symptom-specific medications, supplements, and a personally tailored diet.
Find Help for Alcohol Abuse and Addiction
1st Step Behavioral Health is a licensed dual-diagnosis long-term addiction treatment facility that is accredited by the Joint Commission. We focus on the physiological rebalancing of the individual through medical, physical, emotional, mental, and spiritual care.
If you or a loved one have a drinking problem, there is no better place to begin your recovery journey than our detox center. Our detox programs are tailored to individuals who are dealing with physical dependence on drugs or alcohol, where withdrawal symptoms can be both distressing and, in severe cases, potentially dangerous. We can prescribe medications that alleviate your symptoms and offer 24-hour support and supervision, ensuring your safety and comfort during the detox process.
To learn more about our treatment programs or get started with a confidential, risk-free assessment, please contact us today.
References:
- American Academy of Family Physicians (AAFP): Alcohol Withdrawal Syndrome
- National Institute of Health (NIH): Delirium Tremens
- National Institute of Health (NIH): Delirium Tremens: Assessment and Management
- Science Direct: Delirium Tremens
- JAMA Network: Management of Alcohol Withdrawal Delirium An Evidence-Based Practice Guideline
