Delirium tremens (DTs) is a syndrome that impacts a person who suddenly quits drinking after heavy alcohol use. Many people who drink too much are at risk of experiencing Delirium Tremens, known to be the most severe form of alcohol withdrawal. It may start as early as 8 hours after the last drink is consumed.
According to the CDC, 17% of adults binge drink, and 7% are into heavy drinking, making DTs a common issue. The condition involves hallucinations, loss of awareness, cold sweat, shaking, fever, and seizures. This may get worse in 24 to 72 hours and may last up to 3 to 8 days.
A combination of severe alcohol use, not eating well, and then stopping drinking can cause DT. Learning about the DTs meaning, risk factors, clinical treatment, and how to avoid this life-threatening syndrome is important. In this article, we’ll cover Delirium tremens and how to deal with them.
What is Delirium Tremens?
You may be wondering what is Delirium tremens and how it happens. Delirium tremens is a potentially life-threatening alcohol withdrawal syndrome. A lack of awareness, hallucinations, altered mental state, and sympathetic overdrive indicate this ethanol withdrawal. A person may experience auditory and visual hallucinations, tremors, nausea, and vomiting.
Delirium tremens is also called alcohol withdrawal delirium (AWD) or alcoholic hallucinosis. Some other common names may include shaking frenzy and Saunders-Sutton syndrome.
Delirium tremens happens when a person with severe alcohol abuse disorder suddenly stops drinking. As per the American Addiction Centers, about 3–5% of alcohol users develop severe withdrawal symptoms.
They may experience seizures and mental and physical system breakdowns. Without treatment, DTs have a 37% mortality rate.
Delirium Tremens vs Alcohol Withdrawal
Some people may confuse alcohol withdrawal with Delirium tremens; however, both are different in severity and symptoms. We’ll discuss these disorders right now.
| Characteristic | Alcohol Withdrawal | Delirium Tremens |
| Onset | 6-12 hours after drinking | Within 8 hours to 72 hours of drinking |
| Severity | Moderate | Life-threatening, severe |
| Symptoms | Insomnia, tremors, nausea, anxiety | Cold sweats, hallucinations, confusion, fever, high blood pressure |
| Mortality Rate | Low | Moderate
1-4% (without treatment), 1-2% (with treatment) |
| Prevalence | About 50% | 3-5% |
How Much Alcohol Do I Have to Drink to Get Delirium Tremens?
There may not be a set amount of alcohol to reach Delirium tremens, as it may depend on your current health and several other factors. However, the condition is common in people who consume up to 7 to 8 pints of beer, 2 liters of wine, or half a liter of strong alcohol every day for a few months. Some people may get DTs after ten years of heavy drinking.
The history of prolonged alcohol use makes a person more susceptible to DTs. Besides, if you’ve had previous episodes of severe alcohol withdrawal or delirium tremens, it may happen again if you don’t stop drinking. In some cases, when people have issues with substance abuse and certain medical conditions (heart and liver problems, old age), DT may impact them even more.
Causes and Pathophysiology
Delirium tremens occurs when chronic alcohol users abruptly stop drinking. About 3 to 5% of chronic drinkers are susceptible to getting DTs.
Other risk factors include:
- Chronic alcohol abuse: a person who consumes 5 to 6 drinks every day for weeks or months. Heavy drinking can lead to DTs.
- History of previous Delirium Tremens symptoms: If a person has experienced alcohol withdrawal or Delirium Tremens symptoms in the past, they are more likely to go through these symptoms. Alcohol abuse can often result in these symptoms with prolonged use.
- Coexisting medical conditions: People with medical issues related to the liver, heart, and lungs are predisposed to Delirium tremens. These conditions may worsen the impact of alcohol abuse and lead to severe symptoms. Those with mental health problems such as depression and anxiety are also more likely to develop DTs symptoms.
Neurochemical Changes in the Brain
Certain neurochemical changes in the brain take place, causing DT. Prolonged alcohol abuse can alter excitatory neurotransmitters such as glutamate and downregulate inhibitory neurotransmitters like GABA. When alcohol is abruptly removed from the system, the brain will go into an overstimulated state, resulting in DT.
The chronic intake of alcohol will lead to an increased release of endogenous opiates. This will result in the activation of the inhibitory gamma-aminobutyric acid-A (GABA-A) receptor. Due to this, the increased GABA inhibition will cause an influx of chloride ions.
There will be interactions with serotonin and dopamine receptors in the brain. Suddenly, when you stop drinking, there will be a loss of GABA-A receptor stimulation. This will end up causing symptoms such as tremors, seizures, anxiety, diaphoresis, and tachycardia. Due to this high nervous system excited state, the person will experience DT and impacted brain receptors when abstaining from alcohol.
In addition, the brain’s chronic exposure to alcohol during the withdrawal stage will cause increased levels of dopamine, norepinephrine, and serotonin. This neurotransmitter rise will lead to autonomic hyperactivity, shown as DTs symptoms. The person will experience hallucinations and an agitated state.
Delirium Tremens: Symptoms and Signs
Delirium tremens is said to be the most severe form of alcohol withdrawal. Mental confusion, tremors, and several autonomic disturbances characterize alcohol withdrawal syndrome symptoms.
- Early Symptoms: The initial symptoms will start within 6 to 12 hours of your last drink. They may include insomnia, tremors, agitation, nausea, vomiting, sweating, high blood pressure, and an increased heart rate.
- Advanced Symptoms: These symptoms may progress as the initial symptoms management may not be done properly. Symptoms such as seizures, fever, confusion, disorientation, rapid heart rate, sweating, and hallucinations may begin during this stage.
- Physical Signs: Psychological symptoms may be accompanied by physical symptoms such as cold sweats, fever, dehydration, tremors, swelling, and an irregular heartbeat.
Delirium tremens can last anywhere from 2–3 days to a week in severe cases. Symptoms may reach their peak in 4-5 days and may be the hardest to fight through.
Diagnosis
The diagnosis of DT can be classified into clinical evaluations, followed by diagnostic criteria and differential diagnosis to get the best prognosis.
- Clinical Evaluation: The clinical evaluation will include the physical examination of the patient and preliminary tests based on patient history. The examiner may check the timeline of alcohol use, previous withdrawal episodes, and current symptoms.
- Diagnostic Criteria: The diagnostic criteria will use the DSM-5 criteria. It includes the examination released to address the disturbance in attention and awareness. This will be followed by a check on the development of the disturbance over a few hours to the next few days. The examiner will also check the patient for cognitive issues such as changes in memory, disorientation, perception, and confusion.
Any change from the baseline will also be noted. There should be no evidence of coma or other evolving neurocognitive disorders. The issues in the previous disturbances, if not explained by any existing condition, will be considered to have a persistent impact on DTs. - Differential Diagnosis: The examiner has to rule out any other causes of the symptoms, like psychiatric issues, infections, substance use, and metabolic disturbances.
Treatment and Management
Due to severe symptoms, Delirium tremens may prove fatal. But, when caught in time, it is reversible with ample medical care and Delirium Tremens medication. Therefore, it isn’t permanent, as prompt medical attention may help prevent the symptoms from becoming more severe.
The condition may last anywhere from 2-8 days and require proper medical care. Failure to do so may be fatal, as the current mortality rate is as high as 35%.
Delirium tremens is classified as a medical emergency requiring immediate hospital admission. The patient will need intensive care to prevent the progression of the symptoms and treat the current symptoms with medication.
Providing IV fluids, vitamins, sedatives, and alcohol detoxification can support the treatment. Constant monitoring is needed when the patient is given medication such as benzodiazepines (chlordiazepoxide, diazepam, and lorazepam) and anesthetic agents (propofol, dexmedetomidine, and ketamine). These are alcohol withdrawal syndrome medication names common for DTs symptoms.
Maintaining the right hydration and nutrition is crucial, with ample electrolytes, magnesium, folic acid, dextrose, and thiamine. Another important factor is to provide a calm environment for the patient to recover.
Complications
Complications related to DTs may occur depending on the current symptoms, their damage, and the hangover medical procedure the patient gets. Those with DTs may develop cardiovascular problems, nutritional deficiencies, and mental health issues. Delirium tremens may be prolonged due to poor health or a lack of treatment and the person may remain in the state for weeks.
This may often lead to a decline in overall health. The top complication related to DTs is death, as it has a high mortality rate without treatments. With treatment, the mortality rate comes down to 1-2%.
Alcohol abuse also weakens the immune system, so the person may develop pneumonia, infection, urinary tract infections (UTIs), and skin infections. The delay in Delirium tremens treatments and the onset of severe symptoms can lead to high cognitive decline.
Prevention and Long-Term Management
Ailments related to alcohol use are always preventable. Consuming one or two drinks once in a while may be enjoyable; however, overdoing it as an escape causes addictions. The ideal way to prevent DTs in those with alcohol addiction is to prevent abrupt alcohol cessation.
Early intervention, support group meetings, counseling, and rehabilitation may help people with an alcohol abuse history. Detoxing from alcohol can help an individual safely reduce and stop alcohol consumption to prevent DTs. Rehabilitation programs after surviving Delirium tremens are essential to ensure it does not happen again.
Q&A
How Long Do Withdrawal Symptoms Last from Alcohol?
Alcohol withdrawal symptoms occur within 8 hours of the last drink. The symptoms may be severe at the 24- to 72-hour mark. However, this may go on for weeks.
How Long Does Delirium Tremens Last?
It may last 3 to 4 days and is considered to be a short-lasting condition. In some severe cases, it may be eight days long, followed by a long sleeping session. The person will start to feel better after this.
How Does the Body React When You Stop Drinking?
You may experience nausea, vomiting, cold sweats, a racing pulse, and shaky hands when you stop drinking. Meanwhile, there may be mental and physical symptoms of anxiety.
What Are the Major Symptoms of Delirium Tremens?
The person may experience lethargy, disorientation, mental confusion, a lack of hearing, and difficulty thinking. Their senses of awareness, mood, and perception may suddenly change.
What Is the Best Treatment for Delirium Tremens?
Intermittent intravenous infusions of lorazepam or diazepam may be given as a Delirium Tremens treatment. Other treatments may include sedatives and vitamins to prevent further shock and regain the body’s health. Alcohol detoxification at a medical facility may aid in handling the deteriorating patient’s health.
Conclusion
Now you know how excessive alcohol consumption and sudden quitting may lead to Delirium Tremens. The syndrome is often accompanied by symptoms such as mental confusion, hallucinations, auditory issues, agitation, heart palpitations, and high blood pressure.
DTs may start within 8 hours of stopping alcohol consumption and continue for 3 to 8 days. In severe cases, it can last a few weeks, requiring medical intervention by intravenously giving lorazepam or diazepam. It is crucial to recognize the symptoms early on. The mortality rate for DTs is 37%.
DT must not be confused with simple alcohol withdrawal, as it can be life-threatening. If you or someone you love has an alcohol addiction or substance abuse disorder, get help in time. Consult with medical professionals and support groups to get the help you require.
