Delirium Tremens: When Alcohol Withdrawal Turns Horrific

Last Updated: April 9, 2020

Delirium tremens (DTs) is the most severe side effect of alcohol withdrawal. The symptoms are not only hard on the body and psyche of the sufferer but are also disturbing for loved ones who witness the process without fully understanding it. Terrifying thoughts rush through the mind: Are they dying? Will they have permanent brain damage? Was it the right decision for them to quit alcohol?

This article will help to understand what delirium tremens is and how to prevent its onset when a loved one tries to quit alcohol. It should also help to learn how one can recognize the symptoms of DTs, so one can stay calm and do what is right at that moment, should it ever become necessary.

What Is Delirium Tremens?

Delirium tremens is the sudden onset of severe and abnormal mental and neurological changes. It usually follows a period of withdrawal from alcohol, typically in people who have had a high alcohol intake for over a month. However, the symptoms of DTs can also occur in alcoholics who have contracted an infection or have suffered a head injury.
According to the American Academy of Family Physicians, delirium tremens symptoms usually occur 48 to 96 hours after having the last drink.  In rare cases, the symptoms may show up even 7 to 10 days after the last drink. Signs of delirium tremens are common in chronic abusers of alcohol or in long-term alcoholics who quit “cold turkey.”
According to the National Institutes of Health, heavy users of alcohol are people who have been drinking more than 5 pints of wine or beer or a pint of hard liquor every day for several months.

Delirium tremens (also called the DTs) is a set of symptoms marking an abnormal change in the mental and neurological state of a person who is an alcohol addict. A person suffering from the DTs may experience paranoia, seizures, hallucinations, sensitivity, and disorientation, just to name a few symptoms. This condition typically occurs in people with a regular high intake of alcohol who suddenly stop, triggering alcohol withdrawal. But it can sometimes also occur in people who have had a head injury or severe infections.
The following are risk factors for DTs:

  • History of severe withdrawal symptoms
  • Previous history of delirium tremens
  • Infections and other medical conditions like hepatitis and pancreatitis and other infections
  • Existing mental conditions
  • Old age

Common symptoms of delirium tremens include:

  • Seizures or body tremors
  • Nausea and vomiting
  • Elevated body temperature
  • High blood pressure
  • Rapid heartbeat
  • Excitement and agitation
  • Sensitivity to light and noise
  • Anxiety, fear, and paranoia
  • Hallucinations
  • Confusion and disorientation
  • Stupor or unresponsiveness to touch
  • Sleeplessness
  • Restlessness
  • Decreased focus and attention

Delirium Tremens Symptoms

Young female having hangover or vertigoLearn the delirium tremens signs and symptoms:

  • Body Tremors (Seizures): The whole body shakes violently. Seizures usually occur between 6 and 48 hours of withdrawal. These can occur even in people who have no history of epilepsy.
  • High Body Temperature, High Blood Pressure, and Rapid Heartbeat: These are also among the initial symptoms of DTs. After becoming used to the presence of alcohol, the body goes into overdrive (the rebound effect) when the person suddenly quits alcohol.
  • Confusion and Disorientation: Alcohol affects the region of the brain responsible for perception and analysis. Clouded thinking is a common side effect of alcohol withdrawal, and this symptom intensifies when the person develops DTs.
  • Hallucinations: Delirium tremens hallucinations can be sensory, tactile, and/or visual. This is one of the most common symptoms of DTs.
  • Anxiousness, Fear, and Paranoia: Feelings of anxiousness and paranoia and fears of impending doom are common when there is confusion and thoughts are foggy.
  • Sensitivity to Lights and Sounds: The individual perceives ordinary lights to be brighter than usual and sounds to be louder than usual.
  • Excitement and Agitation: Alcohol consumption depresses the normal functions of the GABA and glutamate neurotransmitters that regulate the workings of the nervous system. So when alcohol is no longer present in the body, these chemicals exhibit a rebound effect and overstimulate the brain. Excitement and agitation follow.
  • Stupor: The person may become unresponsive to touch.
Besides the above-mentioned symptoms, a person experiencing DTs can also exhibit signs like nausea, insomnia, restlessness, decreased focus and attention, and altered mental state.

The symptoms of delirium tremens alcohol withdrawal can worsen if they are not managed and treated promptly. For example, hallucinations and seizures can lead to injuries and accidents. Besides, seizures themselves can be life-threatening. Fear and paranoia can drive a person to commit violent activities. Unchecked tachycardia (rapid heartbeat) can cause a cardiac arrest.

The Causes of Delirium Tremens

There is no definitive answer to what causes delirium tremens, however the most commonly accepted Medical vector illustration, chemical formula of gamma-Aminobutyric acidtheory according to the medical delirium tremens definition is that excess alcohol consumption interferes with the body’s regulation of a specific neurotransmitter, gamma-aminobutyric acid-A (GABA).
In heavy drinkers, the body mistakes alcohol for GABA and therefore reduces its production of it. This means that when that person slows their drinking habits, the body then believes there is no longer enough GABA to function, which causes tremors.
In addition to occurring when a person decreases their drinking habits, quitting alcohol entirely or not eating enough while trying to quit can also cause delirium tremens. This is because alcohol has a lasting effect on the brain’s neurons, one that triggers an excitatory state when its presence is removed. This process can then take months to reverse and can cause an array of problems.

How long do delirium tremens last? Well, there is no definite length of time for a DT episode to last, as it changes from person to person, depending on variables such as BMI (body mass index), length of time drinking, and one’s overall state of health

Other causes of delirium tremens are things like head injuries, infections, and illnesses in alcoholics. In these cases, the illness triggers the same process that would occur in alcohol withdrawal delirium tremens. However, some DT causes such as diabetes and vitamin deficiency are unrelated to alcoholism, so one should always be honest with a doctor, to make sure all possible causes are considered.
Those who have suffered from delirium tremens in the past are predisposed to suffer from them again. Recurrences of delirium tremens are often treated with a drug called Acamprosate to prevent relapses and recurring episodes of DT’s.

Risk Factors For DTs

The primary risk factors for DTs include:

  • History of Alcohol Withdrawal Symptoms: Patients who have a history of severe withdrawal symptoms, especially seizures, are most at risk. Heavy and long-term drinkers tend to experience more intense withdrawal symptoms.
  • History of DTs: A person who has experienced alcohol delirium tremens before has an increased risk of developing DTs every time he quits alcohol.
  • Severe Alcohol Withdrawal Symptoms: A person who is exhibiting severe alcohol withdrawal symptoms has a greater chance of developing DTs. In other words, if a loved one is experiencing severe withdrawal symptoms of other kinds, don’t wait for actual DTs symptoms to appear before the call for medical help.
  • Co-occurring Medical Conditions: Chronic users or alcoholics tend to also suffer from underlying infections and/or medical conditions like hepatitis and pancreatitis. The presence of these conditions may intensify the effects of DTs symptoms or make treatment challenging.
  • Co-occurring Mental Conditions: The presence of some co-occurring mental conditions may intensify symptoms like feelings of anxiety and fear and a tendency to become aggressive.
  • Old Age: Elderly people are more at risk of developing DTs, and exhibit more severe symptoms when they occur.

What To Do If Someone Is Experiencing Delerium Tremens?

Female calling 911Call 911. This is the FIRST thing to do if someone has DTs. DTs can be fatal. DON’T wait or assume that the symptoms will go away on their own.
As one waits for medical help to arrive, make sure to DO the following:

  • Keep a close watch on the person and ensure that they do not sustain injuries from falls and/or collisions.
  • Remove from the vicinity any object that the person might perceive to be a threat.
  • Create a calm and quiet environment to help the person relax until medical help arrives. Make sure there are no loud noises and bright lights in the surroundings.

Because the person is probably not able to think clearly or speak coherently, be prepared to answer the questions that doctors will want to know about his or her drinking habits and substance abuse history, such as:

  • When did the person have the last drink?
  • For how long has he or she been using alcohol?
  • How many drinks does the person consume on a typical day?
  • Did he or she try to quit alcohol before and if so, were there withdrawal symptoms?
  • Did he or she have DTs before?
  • Does he or she use other illicit drugs or prescription medicines?
  • Does the person suffer from any underlying physical or mental disorder and if so, is he or she undergoing treatment for it?

Diagnosis of Delerium Tremens

Stressed Man Working At Desk In Busy Creative OfficeDelirium tremens can often be difficult to identify. However, there are certain symptoms to look out for to make sure to get the help a loved one may need.
Symptoms tend to show themselves within 72 hours of the person’s last drink, although they can begin as late as 10 days after.
If a loved one exhibits at least two of the following symptoms after reducing alcohol consumption, they are showing signs of alcohol withdrawal:

  • Hyperactivity
  • Tremors or Shakes
  • Insomnia
  • Nausea
  • Anxiety
  • Elevated pulse – high blood pressure and temperature

Those who have a history of alcohol withdrawal symptoms are more likely to experience delirium tremens, so take extra care and be vigilant for indications of DTs.
The signs of DTs are:

  • Decreased attention
  • Loss of memory
  • Perception alteration (hallucinations, spatial awareness)
  • Lack of awareness
  • General instability
  • Seizures (extreme cases) – the risk of seizures tends to occur between 6 and 48 hours after quitting alcohol

The signs of delirium tremens may also mimic and replicate those of other dangerous disorders, so these other disorders may need to be proven incorrect before a formal diagnosis of DT is made. Due to the seriousness of DT, the time that this “ruling out of other causes” process can take reinforces the importance of seeing a doctor or health professional as soon as possible. A quick diagnosis may also allow avoiding symptoms in extreme cases such as seizures and deep prolonged sleep, which can, in time, become more dangerous. One of the most important factors to avoiding misdiagnosis is ensuring that there is no evidence of any neurocognitive disorder in the person who seems to be suffering from delirium tremens symptoms.
Delirium tremens death. Due to recent advances in the diagnosis of delirium tremens, the mortality rate has dropped from 35% to 10%. However, it is still vital to recognize the symptoms, and as early as possible. Once a visit a health professional is arranged, they will ask a range of questions about general health, history with alcohol, and how recently has one stopped drinking. A patient will also be asked if they have ever gone through withdrawal previously, as well as what the current symptoms are/have been. This is how other potential conditions will be ruled out, to avoid misdiagnosis.

Delerium Tremens Treatment

Although it is theoretically possible to provide delirium tremens treatment at home, this is rarely recommended because the most effective treatment for DTs can only be provided in a hospital setting. The primary goals of these in-hospital treatment programs are to:

1. Keep the person calm and safe till the symptoms of DTs wear off

The person may need to be sedated until the symptoms wear off. Being sedated keeps him or her injury-free and safe. Benzodiazepine medications like lorazepam or diazepam are sometimes administered.

2. Manage and treat life-threatening symptoms like seizures

Some symptoms of DTs have to be managed with medication to prevent them from worsening and triggering life-threatening complications. For instance, seizures and abnormal (rapid) heart rate have to be treated promptly.

3. Diagnose, manage, and treat co-occurring physical and/or mental disorders, if any, to prevent complications

Antipsychotic medicines can be prescribed to manage any underlying psychiatric condition that would otherwise aggravate the symptoms of DTs. For example, after assessing the risk for seizures, haloperidol is sometimes administered to people who have been diagnosed with schizophrenia.

When a person who is a known alcoholic and is exhibiting the symptoms of DTs is admitted to a hospital, he or she is also examined for underlying medical conditions.

Chronic alcohol users often suffer from a host of physical disorders like alcoholic liver disease, alcoholic cardiomyopathy, alcoholic neuropathy, and Wernicke-Korsakoff syndrome. So in addition to treating the DTs symptoms, doctors may also administer therapies to manage the other physical disorders.

If the symptoms are left untreated, DTs can have a mortality rate of up to 35 percent. But with early detection and prompt delirium tremens treatments, the mortality rate is less than 2 percent. Although all symptoms eventually subside with proper treatment, some like fatigue, sleeplessness, and mood swings may persist for up to a year.

A long-term DTs prevention treatment program is usually built around the following strategies:

  • A medically-supervised detox period
  • Lifelong abstinence
  • Psychological counseling
  • Participating in support groups
Delirium tremens meaning – it’s a warning. The key to preventing a reoccurrence of DTs is not only in quitting alcohol but also continuing to stay away from it.

No alcohol withdrawal symptom should be ignored. Some might resolve on their own, but many like seizures and abnormal heart rhythms don’t. The effects of DTs can worsen and trigger life-threatening complications if not treated promptly.

If a loved one, is going through DTs, remain calm. Keep in mind that hallucinations and disorientation do not signal permanent brain damage. Nor do tremors and breathlessness signal dying. Call 911, and stay near the person till help arrives.

Page Sources

  1. Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014.
  2. Kim DW, Kim HK, Bae EK, Park SH, Kim KK. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Am J Emerg Med. 2015.
  3. Ferguson JA, Suelzer CJ, Eckert GJ, Zhou XH, Dittus RS. Risk factors for delirium tremens development. J Gen Intern Med. 1996.
  4. Lutz UC, Batra A. [Diagnostics and therapy of alcohol withdrawal syndrome: focus on delirium tremens and withdrawal seizure]. Psychiatr Prax. 2010 Sep;37(6):271-8.

Published on: March 9th, 2018

Updated on: April 9th, 2020

About Author

Juliette Siegfried, MPH

Juliette has been working in the health communications field since 1991, when she began working at the National Cancer Institute of the National Institutes of Health in Bethesda, Maryland. Her initial campaigns focused on smoking cessation and cancer prevention. Juliette later moved to the corporate side of health communications, including working at Kaiser Permanente, where she designed interactive computer-based training for health education.


Leave a comment

  • paul
    I believe I am suffering DT or other such withdrawal symptoms. I am just getting to back to work and cannot go to a hospital or clinic for treatment _ I understand water is important to rehydrate. I also saw that people in this condition may be low on calcium, iron, thiamine (sp?), and other vitamins and minerals so I am planning to start taking a vitamin/mineral supplement. I had stopped drinking for 15 years – after meeting two women who gave me the inspiration to be a better me. She passed away just over twenty years ago, a year and a half after our son was born and her daughter (I said two women) was 9. I started drinking again 10+ years ago, but it became worse after our daughter graduated college and moved on with her life – married, has a house and a 1 year old daughter, and back in school nights (to be a nurse). My son spent his freshman year in NYC and is now in LA finishing up a movie/sound career. I need to clean myself up for all of them, and for me. I tried seeking psychiatric help before. It was working but the depression drugs took away that edge you need to be effective as an engineer. That was in Newton, Lower Falls? I can’t remember. I told the psychiatrist what was going, and that I might lose my job since I was becoming ineffective, he told me could protect my job under some Act but I didn’t want to have that stigma attached to my medical records, resume? I did lose that job but got a good one after that – but things went south about 5 years into it – I spoke up against engineering plans my division leader and the director were pushing; I was right as they lost the contract and I was pushed aside – but stayed on to pay the bills raise the kids, etcetera, while my career imploded. I’m still there . . . Staying took a significant toll on my mental and physical health. This sort of feels like the final act of a depressing movie or play, where people are just waiting to sneak out or begging for it to end. Thus the drinking. Feels better having gotten that off my chest. Thanks for reading – if you didn’t already sneak out. So if you could comment on the water, vitamin, mineral options that would be a great help – or start anyway!
    • Mike
      You may be an alcoholic. If so, the only successful treatment is complete, 100% abstinence from alcohol. Self-knowledge, study, rehab programs, prescription drugs (very hyped these days), treatment centers may provide temporary benefits but you will relapse and it may get much, much worse. If you have an alcoholic mind and personality you are a cucumber that has turned into a pickle. You an be and never will be a cucumber again. Your are doomed to repeat the cycle you describer. The only ones who can help you are fellow alcoholics who have stayed sober a long time. You can find them in AA. There you can learn what ails you and how you can stay sober. –All the the other “modern cures’ are pretty much bull-***t but they will be hyped to you by people who are NOT real alcoholics. Get to an AA meeting in your town or the next town over. Good luck.– My name is Mike.
    • Chris
      Or, you might look into Smart Recovery. It’s been a positive for many clients of mine. They offer many tools, many states have groups, and a few treatment centers.
    • Chris H
      I don’t think I filled this out properly. You might what to try Smart Recovery program – it’s pretty different from AA and I’ve heard from clients how much it has helped them. They have support groups in many states and a few treatment programs covered by some insurances. Life gets pretty dang awful sometimes and it’s usually helpful to have folks who understand around us. Continue being curious about what you can make of your life. I hope this one posts.
  • Tommy Chamberlain
    I’ve been struggling with alcohol since early teens and I am about to be 45. I have felt every thing and have had every Dts mentioned. I am recently within the last year became a single father with the help of an angel in form of a beautiful lady and amazing person she has helped me through one of the hardest times in my life. But this year I have maintained my alcohol by becoming more and more addicted to meth. It helps me to not feel the drunkness and act sober and keep things in order. I Know it’s killing me slowly. I am in need of some help but I need to be present for my child. He just turned 9 and I can’t afford to come down and withdrawal because he needs my awareness. Is there anything I can do to have help at home. I want to quit but can’t be comatose for any period of time without someone helping with my son. Desperately seeking quick help and guidance to a better life for my son. He and I both deserve it and I am ready.
  • Jerred
    I’m Jerred and I’m a real alcohlic. I can honestly quote Bob Seger on this “I wish I didn’t know now what I didn’t know then”. I have suffered true Delerium Tremens on multiple occasions. I have had 11 seizures that I know of, pancreatitis twice, diabetes because of the pancreatitis, scars on my tongue from the seizures, hallucinations of all kinds, and liver failure. I didn’t have be on the emergency rooms more times than I can remember. I wish that I didn’t know the pain of DT’s. I didn’t have to go through all of that. If I’d a listened to the people in the rooms I certainly wouldn’t know it. If you think you’re going through delerium tremens you probably are. Don’t be ashamed to get help. Be afraid not to. If you can get that “smart recovery” to work for you more power to ya. There is no replacement for good old fashion AA. As for those “hyped up” prescription meds I say try em. We real alcoholics need all the help we can get. They help me and I’m an alcoholic in the worst kinda way. If your looking at this for yourself don’t hesitate get help. There is a better way.
  • David Brownlee
    I believe my daughter (32 years old) is going through this. I know that she likes to drink but I had no idea that it was a chronic thing. She recently fell apart and luckily we got her to a hospital. She spent 5 days in ICU and is now in a regular hospital room. She can talk to me but she doesn’t seem to make sense. It is like she is talking to me from different parts of her life. Just yesterday she said she had to hang up because she was babysitting and she later asked the nurse if she could see her dog (which passed 2 years ago). Amazingly, about 5 years ago she ran a 1/2 marathon and the Peachtree 10K in Atlanta.