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    Delirium tremens

    DTs; Alcohol withdrawal - delirium tremens

    Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes.

    Causes

    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 is most common in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 - 5 pints of wine or 7 - 8 pints of beer (or 1 pint of "hard" alcohol) every day for several months. Delirium tremens also commonly affects people who have had an alcohol habit or alcoholism for more than 10 years.

    Symptoms

    Symptoms most often occur within 48-96 hours after the last drink. However, they may occur up to 7 - 10 days after the last drink.

    Symptoms may get worse quickly, and can include:

    • Body tremors
    • Changes in mental function
    • Agitation, irritability
    • Confusion, disorientation
    • Decreased attention span
    • Deep sleep that lasts for a day or longer
    • Delirium
    • Excitement
    • Fear
    • Hallucinations (seeing or feeling things that are not really there)
    • Increased activity
    • Quick mood changes
    • Restlessness, excitement
    • Sensitivity to light, sound, touch
    • Stupor, sleepiness, fatigue

    Seizures (may occur without other symptoms of DTs)

    • Most common in first 12 - 48 hours after last drink
    • Most common in people with past complications from alcohol withdrawal
    • Usually generalized tonic-clonic seizures

    Symptoms of alcohol withdrawal, including:

    • Anxiety
    • Depression
    • Fatigue
    • Feeling jumpy or nervous
    • Feeling shaky
    • Headache
    • Insomnia (difficulty falling and staying asleep)
    • Irritability or excitability
    • Loss of appetite
    • Nausea
    • Pale skin
    • Palpitations (sensation of feeling the heart beat)
    • Rapid emotional changes
    • Sweating, especially on the palms of the hands or the face
    • Vomiting

    Other symptoms that may occur:

    • Chest pain
    • Fever
    • Stomach pain

    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
    • Problems with eye muscle movement
    • Rapid heart rate
    • Rapid muscle tremors

    The following tests may be done:

    • Blood magnesium level
    • Blood phosphate level
    • Comprehensive metabolic panel
    • Electrocardiogram (ECG)
    • Electroencephalogram (EEG)
    • Toxicology screen

    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 chemistry results, such as electrolyte levels
    • Body fluid levels
    • Vital signs (temperature, pulse, rate of breathing, blood pressure)

    Symptoms such as agitation, seizures, and irregular heartbeat are treated with the following medications:

    • Sedatives such as diazepam or lorazepam
    • Anticonvulsants such as phenobarbital

    The patient may need to be put into a sedated state for a week or more until withdrawal and DTs are finished. Benzodiazepine medications such as diazepam or lorazepam also help treat seizures, anxiety, and tremors.

    Antipsychotic medications such as haloperidol may sometimes be needed for persons with severe psychotic symptoms, especially if they have an underlying problem such as schizophrenia. However, these drugs should be avoided if possible because they may contribute to seizures.

    Long-term preventive treatment should begin after the patient recovers from immediate symptoms. This may involve a "drying out" period, in which no alcohol is allowed. Total and lifelong avoidance of alcohol (abstinence) is recommended for most people who go through withdrawal. The person should receive treatment for alcohol use or alcoholism, including:

    • Counseling
    • Support groups (such as Alcoholics Anonymous)

    The patient should be tested, and if needed, treated for other medical problems that can occur with alcohol use. Such problems may include:

    • Alcoholic cardiomyopathy
    • Alcoholic liver disease
    • Alcoholic neuropathy
    • Wernicke-Korsakoff syndrome

    Support Groups

    For additional resources, see alcoholism support group.

    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

    • Injury from falls during seizures
    • Injury to self or others caused by mental state (confusion/delirium)
    • Irregular heartbeat, may be life threatening
    • Seizures

    When to Contact a Medical Professional

    Go to the emergency room or call the local emergency number (such as 911) if you have symptoms. Delirium tremens is an emergency condition.

    Prevention

    Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.

    For more information, see: Alcoholism

    References

    O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 32.

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                Review Date: 1/1/2013

                Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

                The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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