Delirium Tremens: When Alcohol Withdrawal Turns Horrific
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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 Does Delirium Tremens Mean
- What Is The Definition Of Delirium Tremens?
- What Are The Symptoms Of Delirium Tremens?
- What Causes Delirium Tremens?
- Risk Factors For DTs
- What To Do If Someone Is Experiencing DTs
- Diagnosis Of Delirium Tremens
- Delirium Tremens Treatment
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, 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.2 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 high regular intake of alcohol who suddenly stop, triggering alcohol withdrawal. But it can sometimes also occur in people who have had a head injury or serious 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
- Confusion and disorientation
- Stupor or unresponsiveness to touch
- Decreased focus and attention
Delirium Tremens Symptoms
“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 symptoms are, they can be unnerving. Learn 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. 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 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.
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 theory 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.
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 you should always be honest with your 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
- 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?
Call 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.
- Keep a close watch on the person and ensure that they 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 to help the person relax until medical help arrives. Make sure there are no loud noises and bright lights in the surroundings.
- 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
Delirium 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:
- 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 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 to avoid 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 a 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.
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 DT symptoms.
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 an 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.
Chronic alcohol users often suffer from a host of physical disorders like an 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.
Keith and Sandra recovered fully from their delirium tremens alcohol 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 counseling
- 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 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.
- Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014. https://www.ncbi.nlm.nih.gov/pubmed/25427113
- 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. https://www.ncbi.nlm.nih.gov/pubmed/25745798
- Ferguson JA, Suelzer CJ, Eckert GJ, Zhou XH, Dittus RS. Risk factors for delirium tremens development. J Gen Intern Med. 1996. https://www.ncbi.nlm.nih.gov/pubmed/8842933
- 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. https://www.ncbi.nlm.nih.gov/pubmed/20803410
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