Delirium tremensDTs; Alcohol withdrawal - delirium tremens
Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes.
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 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
- 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:
- Feeling jumpy or nervous
- Feeling shaky
- Insomnia (difficulty falling and staying asleep)
- Irritability or excitability
- Loss of appetite
- Pale skin
- Palpitations (sensation of feeling the heart beat)
- Rapid emotional changes
- Sweating, especially on the palms of the hands or the face
Other symptoms that may occur:
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
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:
- 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:
For additional resources, see alcoholism support group.
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
- Injury from falls during seizures
- Injury to self or others caused by mental state (confusion/delirium)
- Irregular heartbeat, may be life threatening
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.
Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.
For more information, see: Alcoholism
O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 32.
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.