Delirium tremens is an abnormal change in the mental and neurological state of a person who is an alcohol addict. A person who is suffering from DTs may experience paranoia, seizures, hallucination, sensitivity, and disorientation, just to name a few symptoms. It is also likely to occur to people who have had a head injury or infections.
The following are risk factors of DTs:
- History of severe withdrawal symptoms
- 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
- Confusion and disorientation
- Stupor or unresponsiveness to touch
- Decrease focus and attention
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 also disturbing for loved ones witnessing the process without fully understanding it. Terrifying thoughts rush through their minds: Is he dying? Will she have permanent brain damage? Did I not do the right thing by asking him to quit alcohol?
Understand what delirium tremens is and prevent its onset when a loved one tries to quit alcohol. Learn how you can recognize the symptoms of DTs, so you can stay calm and do what is right at that moment.
What is Delirium Tremens?
Delirium tremens is the sudden onset of severe and abnormal mental and/or neurological changes. It usually follows a period of withdrawal from alcohol. 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, DTs usually sets in 48 to 96 hours after having the last drink.2 It is common in chronic abusers of alcohol or long-term alcoholics who quit cold turkey.
In rare cases, the symptoms may show up even 7-10 days after the last drink. 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.1
Delirium tremens is a potentially life-threatening condition and a medical emergency.
Symptoms of Delirium Tremens
On the first day, I took water and soft drinks. But I couldn’t keep anything down. By evening, I was throwing up blood.
On the second day, my heart was beating violently. I felt as if it would burst out of my chest. I was sweating like a horse. And then the shakes started! I was trembling all over my body, and the shakes were so violent that I felt I would die right then.
That night, I could feel worms crawling up my arms and ants eating away at my insides. Flashes of light exploded in front of my eyes.
I couldn’t remember the emergency number. I am glad somebody discovered me.
This is what Keith recounts as he remembers what happened when he decided to stop drinking. Sandra too shares a frightening story.
I saw a head. A disembodied head that was shriveled and shrunk, but its eyes followed me whenever I moved in bed.
Both Keith and Sandra experienced the telltale symptoms of DTs. To someone who doesn’t know what these are, the symptoms can be unnerving. But if you know someone who is a heavy drinker, learn about the symptoms.
The following are the classic symptoms of DTs:3
- 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 the initial symptoms of DTs. After being used to the presence of alcohol, the body goes into an 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. This symptom intensifies when the person develops DTs.
- Hallucinations: These can be sensory, tactile, and/or visual in nature. This is one of the most common symptoms of DTs. Keith and Sandra were both hallucinating when they were admitted to the hospital. Keith’s hallucinations were tactile in nature because he could “feel” worms on his skin while Sandra had visual hallucinations (seeing a disembodied head).
- Anxiousness, Fear, and Paranoia: Feelings of anxiousness and paranoia and fears of an impending doom are common when there is confusion and the thoughts are foggy.
- Sensitivity to Lights and Sounds: The individual perceives ordinary lights to be brighter and sounds to be louder.
- 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.4
- Stupor: The person may become unresponsive to touch.
The symptoms of DTs can worsen if they are not managed and treated promptly. For instance, 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.
Causes of DTs
There is no definitive answer to what causes delirium tremens, however the most commonly believed theory is that excess alcohol consumption interferes with the bodies regulation of a neurotransmitter, gamma aminobutyric acid-A (GABA).
During DT’s, the body mistakes alcohol for GABA and therefore reduces the 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, causing tremors.
In addition to decreasing drinking habits, stopping entirely or not eating enough when quitting can also cause delirium tremens. This comes down to alcohol having a lasting effect on the brain’s neurons, triggering an excitatory state when removed. This process can then take months to reverse and can cause an array of problems.
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 the alcohol withdrawal would. However some causes are unrelated to alcoholism, such as diabetes and vitamin deficiency, therefore you should always disclose everything to your doctor.
Those who suffer from delirium tremens are also predisposed to suffer from them again. Recurrences of delirium tremens are often treated with Acamprosate, in order to prevent relapsing and causing further DT’s.
Risk Factors for DTs
The risk factors for DTs include:
- History of Alcohol Withdrawal Symptoms: Patients who have a history of severe withdrawal symptoms, especially seizures, are at most risk. Heavy and long-term drinkers tend to experience more intense withdrawal symptoms.
- History of DTs: A person who has experienced DTs 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. Don’t wait for DTs symptoms to show up before you call for medical help.
- Co-occurring Medical Conditions: Chronic users or alcoholics tend to 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.
What Should You Do if You Suspect Someone is Having Delirium Tremens?
Call 911. This is the FIRST thing that you should do if you suspect someone is having DTs. DTs can be fatal; don’t assume that the symptoms will wear off on their own.
As you wait for medical help to arrive, make sure that you DO the following:
- Keep a close watch on the person and ensure that he or she does 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 for the person to relax till 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:
- 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 Delirium Tremens
Delirium Tremens can often be difficult to identify. However, there are various symptoms to look out for to ensure you get the help you or another may need. Symptoms tend to show themselves within 72 hours of your last drink, however, can begin as late as 10 days after.
If you exhibit at least two of these symptoms after you reduce your alcohol consumption you are showing signs of alcohol withdrawal:
- Tremors or Shakes
- 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 the signs of DT.
The signs of DT’s are:
- Decreased attention
- Loss of memory
- Perception alteration (hallucination, spatial awareness)
- Lack of awareness
- General instability
- Seizures (extreme cases) – The risk of seizures tends to come between 6 and 48 hours after quitting alcohol
The signs of Delirium Tremens may also mimic and replicate those of other dangerous disorders therefore many will need to be proven incorrect before a formal diagnosis of DT is made. Due to the seriousness of DT, this reinforces the importance of seeing a doctor or health professional as soon as possible. A quick diagnosis may also allow you to avoid symptoms in extreme cases such as seizures, and deep prolonged sleep, which can, in time, become more. For example, one of the most important factors to avoiding misdiagnosis is ensuring there is no evidence of any neurocognitive disorder in the person claiming to be suffering from Delirium Tremens.
Due to recent advances in the diagnosis of Delirium Tremens the mortality rate has dropped from 35% to 10%, however, it is still just as vital to recognize the symptoms. Once you have decided to visit a health professional, they will ask a range of questions about your general health, history with alcohol and how recently you withdrew and stopped drinking. You will also be asked if you have ever gone through withdrawal previously, as well as what your current symptoms are/have been. This is how other potential conditions will be ruled out, to avoid misdiagnosis.
Delirium Tremens Treatment
The most effective treatment for DTs can only be provided in a hospital setting. The primary goals of the treatment program are:
Keep the person calm and safe till the symptoms of DTs wear off
The person may need to be sedated till the symptoms wear off. Being sedated keeps him or her injury-free and safe as well. Benzodiazepine medications like lorazepam or diazepam are sometimes administered.
Remember Keith? He was administered shots of Librium over a couple of days to keep him sedated and calm. Sedation works in such cases by tempering an overactive nervous system that triggers most of DTs’ symptoms.
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.
Diagnose, manage, and treat co-occurring physical and/or mental disorders, if any, to prevent complications
Antipsychotic medicines are prescribed to manage an underlying psychiatric condition that would otherwise aggravate the symptoms of DTs. For instance, after assessing the risk for seizures, haloperidol is sometimes administered to people who have been diagnosed with schizophrenia.
Chronic alcohol users often suffer from a host of physical disorders like alcoholic liver disease, alcoholic cardiomyopathy, alcoholic neuropathy, and Wernicke-Korsakoff syndrome. So besides treating the DTs symptoms, doctors may also administer therapies to manage the other physical disorders.
If the symptoms are left untreated, DTs has a mortality rate of up to 35 percent. But with early detection and prompt treatment, the mortality rate is less than 2 percent. Although all symptoms subside with proper treatment, some like fatigue, sleeplessness, and mood swings may persist for up to a year.
Keith and Sandra recovered fully from their DTs ordeal and were able to rebuild their lives without alcohol. They willingly underwent long-term preventive therapies after they recovered from their symptoms.
A long-term DTs prevention treatment program is usually built around the following strategies:
- A medically-supervised detox period
- Lifelong abstinence
- Psychological counselling
- Participating in support groups
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 you are around when somebody, especially a loved one, is going through DTs, remain calm yourself. Keep in mind that hallucinations and disorientation do not signal permanent brain damage. Nor do tremors and breathlessness, dying. Call 911, and be near the person till help arrives.