Delirium tremens

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

  • Alternative Names
    • DTs; Alcohol withdrawal - delirium tremens; Alcohol withdrawal delirium

  • Causes
    • 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 is most common in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints (1.8 to 2.3 liters) of wine, 7 to 8 pints (3.5 to 4 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.

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

      Symptoms may get worse quickly, and can include:

      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:

      Other symptoms that may occur:

  • Exams and Tests
  • Treatment
    • 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 patient 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:

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

  • Outlook (Prognosis)
    • 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
  • Possible Complications
    • 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 to Contact a Medical Professional
    • Go to the emergency room or call the local emergency number (such as 911) if you have symptoms. Delirium tremens is an emergency condition.

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

  • References
    • Ferri, FF. Delirium tremens. In: Ferri FF, ed. Ferri's Clinical Advisor 2015. 1st ed. Philadelphia: PA Elsevier Mosby; 2015:p. 357.

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