Delirium tremens
Alcohol abuse - delirium tremens; DTs; Alcohol withdrawal - delirium tremens; Alcohol withdrawal deliriumDelirium tremens is a severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.
Alcohol withdrawal
Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking ...
Read Article Now Book Mark ArticleCauses
Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food.
Delirium tremens may also be caused by head injury, infection, or illness in people with a history of heavy alcohol use.
It occurs most often in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints (1.8 to 2.4 liters) of wine, 7 to 8 pints (3.3 to 3.8 liters) of beer, or 1 pint (1/2 liter) of "hard" alcohol every day for several months. Delirium tremens also commonly affects people who have used alcohol for more than 10 years.
Symptoms
Symptoms most often occur within 48 to 96 hours after the last drink. But, they may occur 7 to 10 days after the last drink.
Symptoms may get worse quickly and can include:
- Agitation, irritability
- Body tremors
- Changes in mental function
- Deep sleep that lasts for a day or longer
- Sudden, severe confusion (delirium)
- Excitement or fear
-
Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Hallucinations
Hallucinations involve sensing things such as visions, sounds, or smells that seem real but are not. These things are created by the mind.
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- Quick mood changes
Mood changes
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
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Restlessness
Restlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
Read Article Now Book Mark Article - Sensitivity to light, sound, touch
-
Stupor, sleepiness, fatigue
Stupor
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
Read Article Now Book Mark ArticleFatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
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Seizures (may occur without other symptoms of DTs):
- Most common in the first 12 to 48 hours after the last drink
- Most common in people with past complications from alcohol withdrawal
- Usually generalized whole body seizures
Generalized whole body seizures
Bilateral tonic-clonic seizure is a type of seizure that involves the entire body. It is also called grand mal seizure. The terms generalized seizu...
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Symptoms of alcohol withdrawal, including:
-
Anxiety, depression
Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
Read Article Now Book Mark ArticleDepression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
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Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
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Headache
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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- Irritability or excitability
-
Loss of appetite
Loss of appetite
A decreased appetite is when your desire to eat is reduced. The medical term for a loss of appetite is anorexia.
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Nausea, vomiting
Nausea
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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-
Pale skin
Pale skin
Paleness is an abnormal loss of color from normal skin or mucous membranes.
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-
Sweating, especially on the palms of the hands or the face
Sweating
Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...
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Other symptoms that may occur:
-
Chest pain
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
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Stomach pain
Stomach pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
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Exams and Tests
Delirium tremens is a medical emergency.
The health care provider will perform a physical exam. Signs may include:
- Heavy sweating
- Increased startle reflex
-
Irregular heartbeat
Irregular heartbeat
An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...
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- Rapid breathing
- Rapid heart rate
- Rapid muscle tremors
The following tests may be done:
-
Blood magnesium level
Blood magnesium level
A serum magnesium test measures the level of magnesium in the blood.
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Blood phosphate level
Blood phosphate level
The phosphorus blood test measures the amount of phosphate in the blood.
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Comprehensive metabolic panel
Comprehensive metabolic panel
A comprehensive metabolic panel is a group of blood tests. They provide an overall picture of your body's chemical balance and metabolism. Metaboli...
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Electrocardiogram (ECG)
Electrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Electroencephalogram (EEG)
Electroencephalogram
An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.
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Toxicology screen (drug test)
Toxicology screen
A toxicology screen refers to various tests that determine the type and approximate amount of legal and illegal drugs a person has taken by measuring...
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Treatment
The goals of treatment are to:
- Save the person's life
- Relieve symptoms
- Prevent complications
A hospital stay is needed. The health care team will regularly check:
- Blood test results, such as electrolyte levels
Electrolyte
Electrolytes are minerals in your blood and other body fluids that carry an electric charge. Electrolytes affect how your body functions in many ways...
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-
Vital signs (temperature, pulse, breathing rate, blood pressure)
Vital signs
Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure. Your health care provider m...
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While in the hospital, the person will receive medicines to:
- Stay calm and relaxed (sedated) until the DTs are finished
- Treat seizures, anxiety, or tremors
- Treat mental disorders, if any
Long-term preventive treatment should begin after the person recovers from DT symptoms. This may involve:
- A "drying out" period, in which no alcohol is allowed
- Total and lifelong avoidance of alcohol (abstinence)
- Counseling
- Going to support groups (such as Alcoholics Anonymous)
Treatment may be needed for other medical problems that can occur with alcohol use, including:
- Alcoholic cardiomyopathy (heart muscle disease)
-
Alcoholic liver disease
Alcoholic liver disease
Alcoholic liver disease is damage to the liver and its function due to alcohol abuse.
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Alcoholic neuropathy (brain and nerve disease)
Alcoholic neuropathy
Alcoholic neuropathy is damage to the nerves that results from excessive drinking of alcohol.
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Wernicke-Korsakoff syndrome (serious brain disease that results from vitamin B1 deficiency, which can be caused by heavy alcohol use)
Wernicke-Korsakoff syndrome
Wernicke-Korsakoff syndrome is a brain disorder due to vitamin B1 (thiamine) deficiency.
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Support Groups
Attending a support group regularly is a key to recovering from alcohol use. More information and support for people with alcohol use disorder and their families can be found at:
Support group
The following organizations are good resources for information on alcohol use disorder:Centers for Disease Control and Prevention -- www. cdc. gov/al...
Read Article Now Book Mark Article- Alcoholics Anonymous -- www.aa.org
- Al-Anon Family Groups/Al-Anon/Alateen -- al-anon.org
- National Institute on Alcohol Abuse and Alcoholism -- www.niaaa.nih.gov
- SMART Recovery - www.smartrecovery.org/
- Substance Abuse and Mental Health Services Administration -- www.samhsa.gov/atod/alcohol
Outlook (Prognosis)
Delirium tremens is serious and may be life-threatening. Some symptoms related to alcohol withdrawal may last for a year or more, including:
- Emotional mood swings
- Feeling tired
- Sleeplessness
Possible Complications
Complications can include:
- Injury from falls during seizures
- Injury to self or others caused by altered mental state (confusion/delirium)
- Irregular heartbeat, which may be life-threatening
- Seizures
When to Contact a Medical Professional
Go to the emergency room or call 911 or the local emergency number if you have symptoms. Delirium tremens is an emergency condition.
If you go to the hospital for another reason, tell the providers if you've been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.
Prevention
Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.
If you have a drinking problem, it is best to stop drinking alcohol completely. Total and lifelong avoidance of alcohol (abstinence) is the safest approach.
References
Kelly JF, Renner JA. Alcohol-related disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 26.
O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 30.
Review Date: 2/28/2023
Reviewed By: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.