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Delirium Tremens: Symptoms and Treatment

Alcohol withdrawal can happen when you suddenly stop drinking alcohol after a period of heavy use.2 Some people at risk for alcohol withdrawal may also develop a severe form of withdrawal called delirium tremens, or DT. It is important to learn the warning signs and how to get help, since DT can be fatal.1,3

What is Delirium Tremens?

Delirium tremens is a somewhat rare but serious form of alcohol withdrawal that can cause sudden, severe mental and nervous system changes.1,2 It is most common in people who:2,3

  • Have a history of alcohol withdrawal.
  • Drink large amounts of alcohol every day for months.
  • Have been drinking for more than 10 years.

While some estimates indicate that more than half of all people with a history of heavy alcohol use will develop withdrawal symptoms when they stop drinking, only about 3 to 5 in 100 people will develop DT.1

Delirium Tremens Symptoms

DT can develop as soon as 48 hours after a person’s last drink, but may occur as many as 7 to 10 days after.2 The most common signs and symptoms of acute alcohol withdrawal, which may appear within hours of taking the last drink, include: 4

  • Tremor (shakiness).
  • Insomnia.
  • Anxiety.
  • Irritability.
  • Nausea and vomiting.
  • Sweating.

Even without treatment, many of these relatively less severe symptoms will clear up within a few days.4

In some cases, more serious withdrawal symptoms may develop within 1 to 2 days of the last drink, including:4

  • Hallucinations (seeing, hearing, or feeling things that aren’t there).
  • Seizures.

Though rarer, DT symptoms may begin after this period of early alcohol withdrawal and can worsen quickly.2 Symptoms of DT may include:1,2

  • Delirium, or sudden, severe confusion and disorientation.
  • Severe agitation (restlessness, pacing, twitching).
  • Fast heart rate (tachycardia).
  • High blood pressure (hypertension).
  • Fever.

Not everyone will progress to delirium tremens symptoms or follow the same alcohol withdrawal timeline. Mild alcohol withdrawal symptoms can start as soon as 8 hours after the last drink and usually peak by 24 to 72 hours.2 More severe symptoms, such as alcohol withdrawal seizures, most often appear in the first 12 to 48 hours after the last drink.2

DT symptoms, on the other hand, can be a concern for a few days beyond this time frame should they develop.2 Not everyone with DT will have seizures, and you can also have seizures without other DT symptoms.2 Other DT symptoms may last as long as 5 days.1, 2

Delirium tremens can be life-threatening.3,4 If you think you or a loved one has DT, call 911 right away.1

Treatment for Delirium Tremens

Without treatment, the risk of dying from delirium tremens is as high as 37 in 100 people.1,3 But early treatment can reduce that risk to less than 5 in 100 people.1

The goals of treatment are to:2

  • Reduce the chance of death.
  • Prevent other health problems.
  • Ease symptoms.

Without the right treatment, the risks of other withdrawal-related problems may worsen, including:1.2.6

  • Seizures.
  • Injury from falls during seizures.
  • Harming self or others while confused.
  • Irregular heartbeat and other heart problems.
  • Severe rhabdomyolysis, a breakdown of muscle cells that can lead to kidney damage.

Because of the risk of seizures, DT, and other alcohol withdrawal problems, early medical treatment can be life-saving.3  In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that a hospital or other forms of 24-hour medical care are the preferred detox settings for those at risk of alcohol withdrawal.7

What to Expect During Alcohol Detox

While in a hospital or other inpatient setting, your care team will check your vital signs (temperature, pulse, blood pressure) and body fluid levels. 2 They will also test your blood to check electrolyte levels and other nutrients.2 Some patients may get thiamine infusions, as many long-term alcohol users have extremely low levels of this vitamin.8

Alcohol detox patients may also get medicines to help ease symptoms, which may include: 1, 8

  • Benzodiazepines (lorazepam, diazepam, or chlordiazepoxide) to manage seizures, agitation, and other symptoms.
  • Barbiturates (phenobarbital), which may sometimes replace benzodiazepines.
  • Other anti-seizure medicines, as needed.
  • Blood pressure medicines.

After alcohol withdrawal and any health issues (such as DT) have been successfully managed, recovery may continue with longer-term measures to help you stay sober. Such measures may include treatment at an inpatient or outpatient rehabilitation center, behavioral therapy, and attending support groups such as Alcoholics Anonymous.

How to Avoid Delirium Tremens

There is no guaranteed way to predict or avoid DT as a problem of severe alcohol withdrawal. However, medical management of the condition can help keep it from getting worse and ultimately save lives. If you think that you or someone you care about is at risk, or if you are worried about your alcohol use in general, you should be aware that the safest setting for alcohol withdrawal is supervised detox and medical withdrawal management.

American Addiction Centers is a nationwide provider of addiction treatment facilities. At each of our facilities, we offer medically supervised alcohol detox to keep you safe and comfortable during withdrawal.

If you are ready to stop drinking, call our confidential, 24/7 addiction helpline at . Our staff can help you learn more about your options and discuss any concerns you may have about detox and treatment, so that you can begin to work toward recovery and sobriety.

Sources

  1. Rahman A. & Paul M. (2020). Delirium tremens. StatPearls Publishing.
  2. MedlinePlus. (2019). Delirium tremens.
  3. Trevisan, L. A., Boutros, N., Petrakis, I. L. & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insightsAlcohol Health and Research World22(1), 61–66.
  4. Saitz, R. (1998). Introduction to alcohol withdrawalAlcohol Health and Research World, 22(1), 5
  5. Sánchez-Manso, J., Muppidi, V. & Varacallo, M. (2020). Autonomic dysfunction. StatPearls Publishing.
  6. MedlinePlus. (2019). Rhabdomyolysis.
  7. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and substance abuse treatment.
  8. Grover, S. & Ghosh, A. (2018). Delirium tremens: assessment and managementJournal of Clinical and Experimental Hepatology8(4), 460–470.
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