Delirium Tremens: What It Is, Causes, Symptoms & Treatment

Your doctor will start with a physical exam and medical history. They may also give you (or a caregiver or loved one who’s with you) a questionnaire called a Clinical Institute for Withdrawal Assessment for Alcohol Revised Scale. This can help them determine your symptoms and measure the severity of your withdrawal. A score of 15 or higher means you’re at high risk for delirium tremens.

Treatment for Delirium Tremens

If someone is already experiencing delirium tremens, immediate medical intervention is necessary. Delirium tremens (DTs) are diagnosed based on medical history, clinical presentation, and physical examination. 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. Symptoms most often occur within 48 to 96 hours after the last drink.

What are other names for delirium tremens?

The key factor in whether DTs is reversible lies in timely intervention. The brain and body’s stress response during severe withdrawal can be mitigated when a specialized medical team intervenes early with the right medications, supportive measures and monitoring. Once acute symptoms subside and the individual recovers, ongoing care—including psychotherapy, support groups and rehabilitation—helps maintain sobriety and reduce the risk of future withdrawal crises. Delirium tremens is an extremely dangerous condition that affects those who have long-term histories of alcohol misuse or who are in the late stage of alcohol use disorders (AUDs). Of that population, more than 50% exhibit alcohol withdrawal symptoms after discontinuing or decreasing their alcohol use. The lifetime risk for developing DTs in this population is approximately 5-10%.

Delirium Tremens Treatment

If you are going to have delirium tremens, usually symptoms start between 2 and 4 days after your last drink. However, some symptoms may not show up until up to 10 days after you give up alcohol. There are a whole range of symptoms, including both physical and psychological issues. One of the priorities in treating this condition is to lower nervous system activity. A healthcare provider will treat this using drugs that reduce how active your CNS is.

In rare situations, people with very high CNS activity may need general anesthesia to fully sedate them and avoid the most dangerous symptoms of DTs. Because confusion is a key symptom of DTs, people with this condition can’t make informed choices about their care. It may be necessary for family or loved ones to make decisions if you can’t make choices for yourself. If you suddenly stop drinking, it’s like the alcohol side letting go of the rope.

• DTs usually last 2-3 days, but symptoms may linger for months in severe cases.
• Discover affordable rehab centers near you, offering easy access and convenience.
• Nearly one-third of U.S. adults will have alcohol use disorder at some point in their lives, and it is estimated that about 1% of those people may get delirium tremens.
• Without medical treatment, up to 35% of people with DTs may die.
• DTs is possible when someone with alcohol use disorder, especially moderate or severe alcohol use disorder, suddenly stops drinking entirely.
• Sometimes, an electroencephalogram (EEG) might be needed to assess brain function if a person is unresponsive.

Treatment

You are more likely to have DTs if you have moderate or severe alcohol use disorder (heavy or frequent alcohol use even if it causes physical or emotional harm). Nearly one-third of U.S. adults will have alcohol use disorder at some point in their lives, and it is estimated that about 1% of those people may get delirium tremens. If untreated, delirium tremens can cause severe symptoms including heart attack, stroke, and death.

The primary cause of Delirium Tremens is suddenly stopping or reducing heavy, long-term alcohol Delirium Tremens Symptoms consumption. Since alcohol causes sedation to the nervous system, an abrupt loss of this chemical can cause over-excitability in the brain and trigger severe physical symptoms. This is one challenge to getting treatment for DTs — if you have hallucinations and confusion, you may not understand that you need to see a doctor. Someone with delirium tremens needs immediate treatment in a hospital. They help lower activity in your CNS, which is the source of most of the dangerous problems with DTs. The most common sedatives are benzodiazepines, but other drug types are possible, too.

Suddenly, your CNS doesn’t have to pull back against alcohol to keep activity at a proper level. That means your CNS is much more active than needed, to the point that it negatively affects automatic body processes. Understanding the timeline of alcohol withdrawal can help you or your loved one know when it’s time to act fast. It’s caused by the brain’s sudden reaction to alcohol being removed from the system. After years of drinking, the brain adapts to having alcohol around.

How is delirium tremens diagnosed?

• Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.
• Even after a phase of decreased or discontinued alcohol use, many people who have this disorder can relapse and start drinking again.
• However, DTs is itself a severe symptom of Alcohol Withdrawal Syndrome and causes its own specific, life-threatening symptoms.
• One of the priorities in treating this condition is to lower nervous system activity.

Doctors may also check your liver, heart, nerves in your feet, and your digestive system to figure out the level of alcohol damage to your body. Because DTs can happen to people at various drinking levels, the best way to avoid DTs is to drink in moderation or not at all. About 29% of adults in the U.S. will meet the criteria for it at some point in their lifetime. If you or someone you love is experiencing signs of DTs, don’t wait.

It can also be more broadly categorized as an alcohol withdrawal symptom. Individuals who have a history of alcohol abuse are often dehydrated and malnourished; therefore, hydration and nutrition are usually prioritized upon admission to prevent organ damage. Thiamine, folate, dextrose, and electrolytes are often administered in an intravenous bag of fluids to help replenish the chemical balance and hydration status. Hallucinations caused by delirium tremens are unique “immersion” hallucinations, meaning that the person believes they are in a different environment than in reality.

Possible Complications

As many of the risk factors for DTs are cumulative or exacerbated by repeated withdrawal episodes, prioritizing professional help early can significantly reduce the chances of developing delirium tremens. Aside from the assessment, laboratory tests are often ordered to help the medical team evaluate the person’s organ function and nutritional status. Delirium tremens typically occur 3-10 days following a person’s last drink. However, for those with severe AUD, DTs can occur as early as 48 hours after abrupt cessation of alcohol and can last up to 5 days. In addition to the management of alcohol withdrawal, you may also need treatment for specific effects of delirium tremens.

If you have signs of delirium tremens, you will need medical care in an acute care hospital setting. This may involve management in the hospital’s intensive care unit. Monitoring and treatment are directed by specific effects you are experiencing and will likely be adjusted as your condition fluctuates.

A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.’s editorial policy, editorial process, and privacy policy. One drink is equal to 14 grams (g.) of pure alcohol, which can take many different forms because some forms have a higher concentration of alcohol than others.

DTs main symptoms include profound confusion, hallucinations (often visual), agitation, tremors, rapid heartbeat, fever, and sweating. In the 1995 film Leaving Las Vegas, Nicolas Cage plays a suicidal alcoholic who rids himself of all his possessions and travels to Las Vegas to drink himself to death. During his travels, he experiences delirium tremens on a couch after waking up from a binge and crawls in pain to the refrigerator for more vodka.