Delirium Tremens: When Alcohol Withdrawal Turns Horrific

Last Updated: April 1, 2021

Reviewed by Michael Espelin APRN

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?

Learn what delirium tremens symptoms are and how to prevent its onset when a loved one tries to quit alcohol. Know how one can recognize the signs of DTs to 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 addiction, typically in people who abuse alcohol for over a month. However, DTs’ symptoms can also occur in alcoholics who have contracted an infection or have suffered a head injury.

Alcohol DT is a potentially life-threatening condition and requires medical emergency help.

Causes of Delirium Tremens

There is no definitive answer about this condition’s causes, but a few factors might become its cause. These are described below:

Excess Alcohol Consumption

According to the medical alcohol DT definition, the most commonly accepted theory 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.

Quitting Drinking Suddenly

In addition to occurring, when a person decreases their drinking habits, quitting it entirely or not eating enough while trying to quit can also cause alcohol DT. This is because alcohol abuse 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.

Alcohol Withdrawal

Alcohol DT is also caused in people who have a history of alcohol withdrawal. It occurs in hard drinkers, drinking many pints of wine, beer, and its other types. It also occurs in people who are its long-term users, i.e., have been using it at least for the last 10 years.

Injuries and Infections

Other causes of this condition 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.

Diabetes and Vitamin Deficiencies

Some alcohol 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.

Delirium Tremens Risk Factors

Evaluation of a patient with DT involves identifying electrolyte, nutrition, and fluid abnormalities. Most of these patients present with severe dehydration (up to 10 L fluid deficit) and severe electrolyte abnormalities, including hypoglycemia and severe hypomagnesemia, and hypophosphatemia.

Other Conditions That Put Patients Under Greater Risk of DTs Are:

  • History of Alcohol Withdrawal Delirium: Patients with 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 withdrawal before has an increased risk of developing DTs every time he quits alcohol.
  • Severe Alcohol Withdrawal Symptoms: A person exhibiting severe alcohol withdrawal delirium 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 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.
  • Advanced Age: Older adults are more at risk of developing DTs and exhibit more severe symptoms when they occur.
Man at risk of developing delirium tremens.

DT Symptoms

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 long-term alcoholics who quit cold turkey.

Common Delirium Tremens Symptoms Include:

  • 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 alcohol withdrawal. 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: Hallucinations can be sensory, tactile, and/or visual. This is one of the most common symptoms of DTs alcohol withdrawal.
  • Anxiousness, Fear, and Paranoia: Feelings of anxiousness and paranoia and fears of impending doom are common when confusion and thoughts are foggy.
  • Sensitivity to Lights and Sounds: The individual perceives ordinary lights as brighter than usual and sounds louder than usual.
  • Excitement and Agitation: Excessive drinking depresses the normal functions of the GABA and glutamate neurotransmitters that regulate the nervous system’s work. 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.

Although all delirium tremens symptoms eventually subside with proper treatment, some like fatigue, sleeplessness, and mood swings may persist for up to a year.

Can Delirium Tremens Cause 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 as early as possible because, with early detection and prompt delirium treatment, the mortality rate is less than 5 percent, according to Abdul Rahman and Manju Paul’s study. The most common conditions leading to death in DTs patients are respiratory failure and cardiac arrhythmias. DTs can cause several complications, which can lead to death.

These Include the Following:

  • Seizures
  • Disorientation
  • Hypertension
  • Hyperthermia
  • Altered mental status
  • Global confusion
  • Arrhythmias
  • Aspiration pneumonitis
  • Respiratory failure

Certain risk factors can also lead to an increased mortality rate, which includes:

  • Pneumonia
  • Pancreatitis
  • Older age
  • Comorbidities

Delirium Tremens Response

Call 911. This is the FIRST thing to do if someone has DTs symptoms. 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?

How Long Does DTs Alcohol Last?

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.

General practitioner receives urine sample from patient.

Diagnosis of Delirium Tremens

Delirium tremens can often be difficult to identify. DTs signs may also mimic and replicate those of other dangerous disorders, so the other disorders may need to be proven incorrect before a DTs’ formal diagnosis is made. Due to DT’s seriousness, 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 doctor will ask the patient about his symptoms and conduct a physical exam.

Some Of The Signs That A Doctor Might Look For Include The Following:

  • Hand tremors
  • Irregular heart rate
  • Fever
  • Dehydration

The doctor may carry out certain tests and screening to diagnose DT. These Tests are Discussed Below:

Toxicology Screen

This test is performed to check the levels of alcohol in the body. This screening is carried out either on the urine or blood sample. It also measures the number of other substances and drugs in the patient’s body.

Blood Magnesium Level

Measuring serum magnesium levels through a blood test may indicate alcoholism or its withdrawal. Low levels of magnesium in the body can indicate severe alcohol withdrawal delirium, which can cause DT.

Blood Phosphate Level

A doctor may check the blood phosphate levels of the patient to diagnose DT. This is indicated through low levels of phosphate.

Comprehensive Metabolic Panel

A comprehensive metabolic panel can allow the doctor to check the patient’s overall health and look for abnormal results that may indicate alcoholism.

ECG

An electrocardiograph (ECG) is carried out to check for any abnormalities in the heart’s electrical activity. Individuals going through alcohol withdrawal experience heart palpitations and arrhythmias, which can be detected through an ECG.

EEG

An electroencephalogram (EEG) checks the electrical activity in the brain. Individuals who suffer from seizures because of severe alcohol withdrawal will have abnormal EEG results.

Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar)

This test consists of a series of questions that a doctor may ask the patient to check if he is going through alcohol withdrawal.

The Questions May Include the Following:

  • Who are you?
  • What day is it?
  • Do you feel sick or nauseated?
  • Do you feel bugs crawling on your skin?
  • Do you feel a band around your head?

Based on these questions and others, the doctor may evaluate the severity of the patient’s symptoms. There are ten symptoms that doctors can evaluate.

These Include:

  • Agitation
  • Anxiety
  • Auditory disturbances
  • The inability to think clearly
  • Headache
  • Nausea
  • Sudden, uncontrollable sweating
  • Tremors
  • Tactile disturbances
  • Visual disturbances

Delirium Tremens Treatment

Although it is theoretically possible to provide delirium 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 In-Hospital Delirium Treatment Programs Are To:

Keep a 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.

Manage and Treat Life-Threatening Symptoms Like Seizures

Some DTs symptoms 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. Multivitamins and thiamine should be given to a patient before glucose to prevent Wernicke encephalopathy.

Recurrences of delirium tremens are often treated with Acamprosate to prevent relapses and recurring episodes of DT’s. Antipsychotic medicines can be prescribed to manage any underlying psychiatric condition that would otherwise aggravate DTs’ symptoms. For example, after assessing the risk for seizures, haloperidol is sometimes administered to people who have been diagnosed with schizophrenia.

Treat Co-Occurring Physical and/or Mental Disorders to Prevent Complications

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. In addition to treating the DTs symptoms, doctors may also administer therapies to manage the other physical disorders.

Long-Term DTs Treatment

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

  • A medically-supervised detox period
  • Lifelong alcohol abstinence
  • Psychological counseling
  • Participating in support groups

DTs meaning – it’s a warning. The key to preventing a recurrence of DTs is not only in quitting alcohol but also continuing to stay away from it.

Any alcohol withdrawal delirium symptoms 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.

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Page Sources

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Published on: March 9th, 2018

Updated on: April 1st, 2021

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.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.