Delirium Tremens (DT)

What is Delirium Tremens (DT)

Delirium tremens, also known as DTs, is the most severe form of alcohol withdrawal. Alcohol withdrawal is a group of mental and physical symptoms that can develop when a person who drinks heavily and regularly stops drinking or drinks less than usual.

Delirium tremens is a serious condition and can be life-threatening. It must be treated in a hospital or a treatment center.

What are the causes?

Heavy and regular drinking can cause chemicals that send signals from the brain to the body (neurotransmitters) to deactivate. Alcohol withdrawal, including Delirium Tremens, develops when deactivated neurotransmitters reactivate because a person stops drinking or drinks less than usual.

What increases the risk of Delirium Tremens?

The more a person drinks and the longer he or she drinks, the greater the risk of Delirium Tremens. This condition is more likely to develop in:

• People who have had severe alcohol withdrawal or DTs in the past.
• People who have had a seizure during a previous episode of alcohol withdrawal.
• Elderly people.
• Pregnant women.
• People who use illegal drugs.
• People who take medicines to help them relax (sedatives).
• People who have certain medical problems, including:
  • Infection.
  • Heart, lung, or liver disease.
  • History of seizures.
  • Mental health problems.

What are the symptoms of Delirium Tremens?

Early symptoms of alcohol withdrawal happen before symptoms of Delirium Tremens. These symptoms may start within 6 hours after the most recent drink, and they may last for 5–7 days. Early symptoms of alcohol withdrawal may include:

• Difficulty sleeping.
• Anxiety.
• Difficulty thinking clearly.
• Irritability.
• Fast heart rate.
• Fast breathing.
• Headache.
• Nausea and vomiting.
• Fever.
• Excessive sweating.
• A heartbeat that feels irregular or faster than normal (palpitations).
• Involuntary shaking or trembling (tremor) of a body part.

Symptoms of Delirium Tremens may begin after early withdrawal symptoms. These symptoms may start to develop 3 days after the most recent drink. They may last for up to 8 days. Symptoms of DTs may include:

• Changes in attention and awareness.
• Sudden changes in heart rate and rhythm, body temperature, and blood pressure (vital signs).
• Feeling or seeing things that other people do not feel or see (hallucinations).
• Extreme sleepiness (stupor).
• Extreme confusion.
• Seizures.

How is this diagnosed?

Delirium Tremens may be diagnosed based on:

• Medical history.
• History of alcohol consumption.
• Symptoms.
• Blood tests.
• Urine tests.
• A physical exam. The health care provider may check for:
  • Fever.
  • High blood pressure.
  • Rapid heart rate.
  • Overactive reflexes.
  • Tremors.

How is Delirium Tremens treated?

Treatment for Delirium Tremens is done in a hospital or treatment center. It may include:

• Monitoring your vital signs.
• Receiving fluids and minerals (electrolytes) through an IV tube.
• Sedatives.
• Medicines that reduce anxiety.
• Medicines to control your blood pressure.
• Medicines to prevent or control seizures.
• Multivitamins and B vitamins.
• Having ongoing counseling and mental health support if you have a history of alcohol abuse or if you used an illegal drug.

What can guide the management of Delirium Tremens? 

DT is a special type of delirium that generally manifests about 3 days into withdrawal from heavy use of gamma-aminobutyric acid agonists (e.g., alcohol, benzodiazepines, barbiturates).

Features of Delirium Tremens include tremors, autonomic hyperactivity (fever, hypertension, tachycardia, diaphoresis), disorientation and confusion, and visual, auditory, or tactile hallucinations.

Untreated, seizures and even status epilepticus may follow, and the potential for mortality is high.

The Clinical Institute Withdrawal Assessment for Alcohol is a useful scale that quantifies the severity of withdrawal symptoms and helps to guide appropriate benzodiazepine administration.

Follow these instructions at home:

• Do not drink alcohol.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or operate heavy machinery until your health care provider approves.
• Drink enough fluid to keep your urine clear or pale yellow.
• Have someone stay with you or be available to you in case you need help.
• Consider joining a 12-step program or another alcohol support group.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have symptoms that get worse or do not go away.
• You cannot eat or drink without vomiting.
• You are struggling with not drinking alcohol.
• You cannot stop drinking alcohol.

Get help right away if:

• You have a seizure.
• You have a fever along with other symptoms of alcohol withdrawal.
• You become extremely confused.
• You have hallucinations.
• You become extremely sleepy.
• You vomit blood.
• You have extreme tremors or sweating.
• You have palpitations.
• You have chest pain.
• You have difficulty breathing.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services. Do not drive yourself to the hospital.