What Is Delirium Tremens?
Delirium tremens, also called DTs or alcohol withdrawal delirium (AWD), is an uncommon, severe type of alcohol withdrawal. It's a dangerous but treatable condition that starts about 2-3 days after someone who’s dependent on alcohol suddenly stops drinking.
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.
How long does delirium tremens last?
DTs usually last 2-3 days, but symptoms may linger for months in severe cases. Your chances of recovering sooner and having a good outcome are better if you get treated quickly, have more moderate alcohol use, and don't have other medical issues, such as dementia or heart disease, which could complicate the condition.
Delirium Tremens Causes and Risk Factors
Alcohol is a depressant. It slows your brain and nervous system. When you suddenly stop drinking after a long period of alcohol use, your brain and nervous system can’t adjust quickly. Your brain gets overstimulated.
People with alcohol use disorder who suddenly stop drinking may also have a spike in an amino acid called glutamate. Glutamate causes some common delirium tremens symptoms, such as a sudden, extreme spike in blood pressure, tremors, severe excitability, and seizures.
You are more likely to have delirium tremens if you:
- Are an adult man or assigned male at birth (AMAB), especially if you are white, younger, and unmarried
- Have a history of seizures
- Have gone through alcohol withdrawal before
- Are a heavy, long-term drinker (you've used alcohol heavily for more than 10 years)
- Have another substance use disorder when you stop alcohol use
- Are over the age of 30
- Have a medical condition such as liver or cardiovascular disease
Heavy drinking is usually considered consuming four or more drinks in one day or eight in a week for women and people assigned female at birth (AFAB). For men and those AMAB, heavy drinking is five or more drinks in a day and 15 during a week.
One standard drink is considered to be:
- 12 ounces of beer
- 8-9 ounces of malt liquor
- 5 ounces of wine
- 1.5 ounces of 80-proof liquor or distilled spirits, such asvodka, rum, or whiskey
If you drink enough alcohol to be considered a heavy drinker (especially if you've done it for 10 years or more), and you want to stop completely, talk to your doctor. Delirium tremens isn't curable, but it can be treated to help you manage symptoms and avoid complications such as dehydration.
Delirium Tremens Symptoms
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.
Physical symptoms can include:
- Tremors, or shaking hands and feet
- Chest pain
- Deep sleep that lasts a day or longer
- Dehydration
- Fever
- Heavy sweating
- High blood pressure
- Nausea or vomiting
- Other tremors, including muscle tremors
- Pale skin
- Passing out
- Problems with eye muscle and movement
- Rapid heartbeat
- Seizures
- Sensitivity to light, sound, and touch
Delirium tremens can cause your body temperature, breathing, or blood circulation to change quickly. This could lead to life-threatening complications such as sepsis, irregular heartbeat, trouble breathing, seizures, or an electrolyte imbalance, a condition when the minerals that control your body’s functions are out of whack.
Psychological symptoms include:
- Confusion
- Excitability or anger
- Getting startled more easily
- Nightmares
- Severe hyperactivity
- Sleepiness, stupor, or fatigue
Delirium tremens hallucinations
Another symptom of DTs is hallucinations. These happen in a very small number of people during withdrawal. You may hear things that seem very real to you, but they aren't there. Even less often, people see, feel, smell, or even taste things that aren't real. Hallucinations during withdrawal tend to begin shortly after stopping alcohol use, typically emerging within 12 hours to about 3 days.
You are more likely to have hallucinations, along with other DT symptoms, if you:
- Are a long-time drinker
- Are using other drugs such as methamphetamines or cocaine
- Have a history of mental health issues including depression, post-traumatic stress disorder, or bipolar disorder
- Live alone
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. Call 911 if you or someone you know has symptoms.
Delirium Tremens Diagnosis
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.
Other tests that your doctor might do include:
- Blood magnesium level
- Blood potassium level
- Electrolyte levels
- Electroencephalogram (EEG) to test brain activity
- Lumbar puncture test to examine spinal cord fluid
- Metabolic panel
- MRI to look for signs of seizures or head injury
- Toxicology screen (blood or urine)
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. You may also be low on vitamins because of an unhealthy diet.
Delirium Tremens Treatment
Symptoms of DTs tend to begin soon after you stop drinking alcohol and can happen abruptly. Because of this, it's best to talk to your doctor before stopping alcohol use. They can help you set up a plan to manage your alcohol withdrawal symptoms. If you have stopped using alcohol, haven't talked to your doctor, and think you might be having DTs symptoms, call 911.
Delirium tremens treatment begins at the hospital. The treatment aims to help relieve your symptoms, reduce the chance of complications and, if DTs are bad, save your life. Sedatives, usually benzodiazepines, are medications used to treat alcohol withdrawal and DTs. They help calm your excited nervous system. If your symptoms can't be managed with sedatives, your doctor may prescribe anesthesia so you will be completely sedated until your symptoms end. You may also need intravenous fluids with vitamins and minerals to treat dehydration or bring your electrolytes back into balance.
Other drugs used in the hospital to treat acute DTs symptoms include:
- Antipsychotic drugs to help calm you and prevent hallucinations
- Anticonvulsants to stop seizures
- Blood pressure medications
- Drugs to regulate your heartbeat
- Pain medication
You may need to stay in the hospital for up to a week to stabilize your health. After that, you should get treatment for alcohol dependence. The government’s Substance Abuse and Mental Health Services Administration (SAMSHA) has an online treatment facility locator at findtreatment.samhsa.gov or you can call their helpline at 1-800-662-4357. Cognitive behavioral therapy (CBT) or recovery support groups, such as Alcoholics Anonymous, may help you stay sober moving forward.
You may be concerned about having DTs symptoms or nervous about seeking treatment. Your doctor and other providers aren't there to judge you but to help manage your symptoms and improve your chances of recovery.
Complications of Delirium Tremens
Aside from the symptoms of delirium tremens, you may also have other complications after stopping your alcohol use. These can be short- and long-term, and your doctor can help you manage them. They include:
- Seizures
- Irregular heartbeat
- Falls or injuries caused by confusion or seizures
- Side effects from the medication you take to relieve symptoms (which will vary depending on your treatment)
Another potential complication of DTs is Wernicke-Korsakoff syndrome. This condition is caused by a lack of thiamine (vitamin B1) and can be a result of long-term alcohol misuse. Symptoms of Wernicke-Korsakoff syndrome include:
- Long-term memory loss
- Tremors
- Vision problems
- Hypothermia
- Coma
Delirium Tremens Prevention
The only way to prevent delirium tremens is to stop, or dramatically reduce, your alcohol intake.
The best ways to prevent severe symptoms after you stop drinking alcohol are close supervision by your doctor and treatment that usually includes benzodiazepines.
Takeaways
Delirium tremens can be a life-threatening condition. One main and serious symptom is the occurrence of hallucinations, which need to be treated by a doctor. If you, or someone you know, has DTs, call 911 immediately.
