Delirium Tremens: Symptoms, Treatment and Prevention

Last Updated: May 17, 2024

Dr. Norman Chazin Reviewed by Dr. Norman Chazin
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For individuals struggling with alcohol use disorder (AUD), the path to recovery can be challenging. While many experience withdrawal symptoms upon quitting, a small percentage face a potentially life-threatening complication called delirium tremens (DTs).

DT represents the most severe form of alcohol withdrawal, impacting only 3-15% of AUD patients. Characterized by a rapid onset, sometimes occurring within 48 hours of stopping chronic alcohol consumption, DT can last up to 10 days and requires immediate medical intervention.

Recognizing the early warning sign of DT alcohol is crucial, as it can have fatal consequences if left untreated. Read on to learn how to identify the delirium tremens symptoms and ensure a safe and successful detox process.

What Is Delirium Tremens?

Delirium tremens (DTs) is a severe and potentially life-threatening condition as a complication of alcohol withdrawal.

It represents the most extreme form of alcohol withdrawal, typically manifesting in individuals with alcohol use disorder (AUD) who suddenly reduce or stop their alcohol consumption (2–4 days after last drink) after a period of heavy and prolonged use.

Delirium tremens is characterized by:

  • A rapid onset of confusion
  • Severe agitation
  • A shaking tremor
  • Autonomic instability

Delirium tremens is considered a medical emergency due to its potential complications, which can include seizures, cardiac arrhythmias, and severe electrolyte imbalances. Early treatment has reduced the mortality rate of delirium tremens to below 5%. However, without prompt treatment, death is still a possibility.

Delirium Tremens Risks Factors

If heavy drinking is a common factor in the occurrence of delirium tremens, why does only a relatively small percentage (3-15%) of individuals with alcohol use disorder (AUD) experience them?

Let’s explore the risks factors for delirium tremens:

Severity and Duration of Alcohol Use

The risk of DTs generally increases with the amount and duration of alcohol consumption. Those with a longer history of heavy drinking are more susceptible to DTs alcohol withdrawal complications.

Prior Alcohol Detoxification Episodes

Research affirms that those who have undergone withdrawal symptoms before, especially severe ones or multiple episodes of withdrawal, are more likely to develop DT in subsequent withdrawal periods.

Co-occurring Medical Conditions

Pre-existing medical conditions, such as electrolyte imbalances, malnutrition, head injury, or infections, can increase the risk and severity of DTs. Research suggests that an increase of serum potassium levels is a significant risk factor for lethal outcomes in patients with DTs.

Genetic Predisposition

Alcohol dependence is already influenced between 40 and 60% by genetics. Genetic factors may make certain individuals more susceptible to developing DT, which remains unclear. Yet, research suggests that hereditary predisposition can play a role in how the body metabolizes alcohol and manages stress, which could influence the risk.

Age and Biological Sex

Older individuals and possibly males may have an increased risk of DT, although the reasons are not fully understood. It may relate to the cumulative effects of alcohol use over time or differences in body composition and metabolism.

Rate of Alcohol Withdrawal

The speed at which someone stops drinking can also be a factor. Abrupt alcohol cessation, known as cold turkey, after heavy drinking is more likely to trigger DTs alcohol than a gradual taper under medical supervision.

Delirium Tremens Symptoms

One of the most dangerous characteristics of delirium tremens is the swiftness with which it can develop.

This alcohol withdrawal phase is marked by a range of severe symptoms. These symptoms typically begin 48 to 96 hours after the last drink but can appear up to 8 days later, frequently ending with a period of prolonged sleep.

Symptoms of delirium tremens include:

  • Disorientation, difficulty focusing and memory impairment.
  • Difficulty in maintaining coherent thoughts or conversations.
  • Increased restlessness, irritability and even aggression.
  • Individuals might see, hear or feel things that aren’t there.
  • Rapid heart rate, sweating, fever, high blood pressure, delirium tremors and seizures.
  • Increased sensitivity to light, sound, and touch.
  • Excessive thirst, vomiting and diarrhea.
  • Problems with sleeping, including intense nightmares.

How Long Do DTs Last?

While delirium tremens can be a terrifying experience, the good news is that they typically run a limited course. They can be reversible and non-fatal with proper medical intervention. If left untreated, about 60% of patients with DT may develop a largely irreversible global amnestic syndrome.

Here is an approximate chart outlining the progression of DTs:

Time Since Last Drink Symptoms
48 to 72 hours Start with severe confusion, hallucinations, tremors, rapid heartbeat, fever, and agitation.
72 to 96 hours Symptoms peak in intensity. Delirium and hallucinations may become more severe, along with an increased risk of seizures and cardiovascular complications
4 to 7 days Symptoms gradually start to subside but may still be severe. Medical intervention and support are crucial during this period to prevent complications.
7 to 10 days DT symptoms usually begin to improve, but cognitive and mood issues can linger, requiring ongoing medical support.
Beyond 10 days By this stage, most symptoms should have subsided, yet individuals might still face lingering effects and need continued support for alcohol dependence.

Delirium Tremens Treatment

Delirium tremens require immediate medical attention due to its life-threatening potential.

Delirium tremens treatments typically involve a combination of medication, supportive care, and monitoring in a hospital setting. The main goals of treatment are to reduce the immediate symptoms of withdrawal, prevent complications, and support the body’s recovery.

Delirium Tremens Medication

Medication-assisted treatment (MAT) with benzodiazepines is the first-line medication for managing delirium tremens.

They help to reduce agitation, prevent seizures, and promote sedation. Lorazepam, oxazepam (for those with impaired liver function), diazepam (for those with a previous history of seizures), and chlordiazepoxide (uncomplicated DT withdrawal) are commonly used.

Supportive Care

Reassurance, hydration with fluids and electrolytes, and monitoring vital signs are essential to supportive care. Continuous monitoring for cardiac issues, seizures, and changes in mental status is crucial. Supportive care also includes addressing any co-occurring medical conditions.

Alcohol Detoxification

Once the acute phase of DTs subsides, a medically supervised detox program may be recommended to wean the individual off alcohol and prevent relapse safely.

Delirium Tremens Prevention

For those planning to stop drinking, gradually reducing alcohol intake rather than abrupt cessation can help prevent the onset of severe withdrawal symptoms, including DT.

  • If you drink alcohol, do so in moderation. This is the most effective way to prevent DTs.
  • If you struggle with alcohol use disorder (AUD), seek supervised detox programs.
  • Be honest with your doctor about your alcohol consumption.
  • Engage with support groups and counseling for emotional and psychological support.
  • Take care of your physical and mental health.

What are Delirium Tremens? − Bottom Line

The significant reduction in the mortality rate of delirium tremens to less than 3–5%, underscores the improvements in medical care and treatment strategies.

Yet, the risk of death remains, often due to complications arising from concurrent alcohol-related conditions such as hepatitis, aspiration pneumonia, and fatal cardiac arrhythmias. Delirium tremens remain a critical concern for individuals with a history of heavy alcohol consumption.

Early detection, prompt medical attention, and comprehensive preventive strategies for managing alcohol withdrawal remain the cornerstones of a good outcome.

People Also Ask

What are delirium tremens?

Delirium Tremens (DT) is a severe form of alcohol withdrawal characterized by confusion, rapid heartbeat, fever, and hallucinations. It occurs in individuals with a history of heavy drinking who suddenly reduce or stop their alcohol intake.

How rare is delirium tremens?

Delirium Tremens (DT) is relatively rare, occurring in 3-15% of individuals undergoing alcohol withdrawal who have a history of heavy alcohol use.

How much alcohol does it take to cause delirium tremens?

Delirium tremens typically occur in individuals with a long history of heavy drinking, often involving daily alcohol consumption over several years rather than a specific quantity of alcohol.

Page Sources

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Retrieved on May 17, 2024.

Published on: March 9th, 2018

Updated on: May 17th, 2024

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