What Is Delirium Tremens?

What Is Delirium Tremens?

Delirium tremens, also known as the DTs or alcohol withdrawal syndrome, is the most severe form of alcohol withdrawal. Symptoms of delirium tremens usually begin within two to five days of quitting drinking and last around two to three days. The experience of going through delirium tremens can vary from person to person depending on the duration and frequency of their previous alcohol consumption.

Only about 5% of people going through withdrawal experience DTs. Heavy, long-term alcohol users are more likely to experience delirium tremens during withdrawal.

Causes

Delirium tremens can occur when people who consume alcohol heavily reduce their alcohol intake quickly or suddenly stop drinking altogether. Heavy drinking is defined as eight or more drinks per week for women and 15 or more drinks per week for men.

Alcohol is a depressant, which means that it slows down the central nervous system. Chronic, heavy alcohol use can create changes in how the brain works, including how the brain's chemical messengers function. When alcohol consumption suddenly stops, the brain continues working in the state it has become used to, leading to symptoms of alcohol withdrawal. 

People have a higher risk of developing delirium tremens if they have been drinking for a long period of time, have experienced alcohol withdrawal in the past, have experienced delirium tremens in the past, or have a seizure disorder.

Delirium Tremens Symptoms

Delirium tremens typically begins after a person decides to give up alcohol after a binge, period of heavy drinking, or when they realize that they need to quit drinking. While people sometimes go through this process at home, it is also common for people to choose to go through alcohol withdrawal and detoxification at a medical facility.

Physical Symptoms

The DTs usually don't begin right away. A person who stops drinking will often experience a period of milder alcohol withdrawal symptoms that become increasingly severe after 48 to 96 hours. However, symptoms may also begin as long as seven to 10 days after a person quits drinking.

• Chest pain
• Deep sleep
• Fatigue
• Fever
• Increased heart rate
• Involuntary muscle movements or contractions
• Nausea
• Seizures
• Sensitivity to light, sound, and touch
• Stomach pain
• Tremors

Some people may also experience changes in heart rate or breathing that are potentially fatal. 

Psychological Symptoms

Along with physical symptoms, these psychological symptoms are also common.

• Anxiety
• Confusion
• Delirium 
• Delusions
• Disorientation
• Excitement
• Fear
• Hallucinations
• Irritability
• Rapid mood changes
• Nightmares
  

Diagnosis

In order to diagnose delirium tremens, a doctor will conduct a physical exam, look at your medical history, and ask you questions about your symptoms. Some signs that they will look at include checking for fever and dehydration. They will also listen to your heart to seek if you are experiencing signs of a rapid or irregular heartbeat.

A doctor may also administer an assessment known as the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) in order to gauge the nature and severity of your symptoms.

Testing

Doctors may also conduct a variety of lab tests including electrocardiograms (ECGs) and blood tests.

• Blood magnesium level: This lab test checks the magnesium serum levels in your blood. Very low levels of magnesium can affect the ability of the heart to function normally and are a sign of alcoholism or severe withdrawal.
• Electrocardiograph (ECG): This test looks at the electrical activity of the heart and can help doctors evaluate the functioning and condition of your heart.
• Electroencephalogram (EEG): This test evaluates the electrical activity in the brain. Severe alcohol withdrawal can cause changes in the brain that can lead to seizures.
• Toxicology screen: This test measures how much alcohol is in your body and is usually performed by testing a blood or urine sample.

Treatment

The DTs are a medical emergency that requires hospitalization. Treatment is focused first and foremost on saving the individual's life, preventing complications, and minimizing symptoms.

Acute Care

Treatment may include the use of benzodiazepines to reduce the symptoms of alcohol withdrawal. Some of the medications that are used to treat delirium tremens include Ativan (lorazepam) and Librium (chlordiazepoxide). Such medications may help relieve the anxiety that is associated with severe, acute alcohol withdrawal.

Heavy alcohol use can also result in nutritional deficiencies. Doctors may also recommend vitamins and minerals including thiamine, zinc, phosphate, magnesium, and folate. 

With medical treatment, mortality rates for DTs are around 5%. Without appropriate treatment, between 15% to 35% of cases may be fatal.

Long-Term Treatment

Once an individual's health and safety have been addressed, treatment may then focus on long-term approaches to aid in recovery from alcohol dependence. These treatments may incorporate group therapy, cognitive-behavioral therapy (CBT), and support groups.

If you need help to stop drinking, there are resources available. Support groups such as Alcoholics Anonymous and Al-Anon can provide information and social support as you go through this process. You can even attend meetings online.

Complications

In addition to delirium tremens, heavy alcohol use can cause other complications that also require treatment.

• Alcohol-related liver disease: Cirrhosis and scarring of the liver that can lead to liver failure
• Alcoholic cardiomyopathy: Heart failure
• Alcoholic neuropathy: Nerve damage caused by excessive drinking
• Wernicke-Korsakoff syndrome: Brain disorder that leads to permanent damage to areas of the brain including the hypothalamus and thalamus

Other health problems that can occur from long-term, excessive alcohol use include stroke, digestive problems, cancer, mental health problems, and weakening of the immune system.

A Word From Verywell

While not everyone who goes through alcohol withdrawal experiences delirium tremens, you should still inform your doctor about your plan to stop drinking. Alcohol withdrawal can be dangerous and potentially fatal, so you should always go through this process under the supervision of a medical professional.

The problem is that no one knows until they quit how severe their withdrawal symptoms will be. If you're a longtime drinker or a heavy drinker and you plan to quit, consult with your healthcare provider or seek treatment from a professional detoxification facility.