Delirium Tremens (DTs): What is it, Signs, Timeline, Risk Factors & Treatment

Alcohol, when consumed in moderation, can be part of a healthy lifestyle. On the other hand, drinking large quantities of alcohol, especially over the long-term, can lead to alcohol addiction.

What is Delirium Tremens?

When a person becomes addicted to alcohol, a professional will diagnose an alcohol use disorder. One of the symptoms of an alcohol use disorder is the experience of withdrawal, or unpleasant side effects, when a person reduces alcohol consumption or stops drinking. Withdrawal occurs because the body becomes dependent upon alcohol and then does not function properly without it.

Sometimes alcohol withdrawal is mild and includes symptoms such as tremor, headache, and upset stomach, which pass within a few days, according to the Industrial Psychiatry Journal. On the other hand, severe cases of withdrawal can lead to a serious condition called delirium tremens. Experts report that only about 5 percent of people who suffer from alcohol withdrawal will experience delirium tremens, but those who do will require immediate medical treatment.

Signs of Delirium Tremens

As the authors of a 2015 report in the journal Drugs have explained, delirium tremens results in severe physical symptoms. These include sweating, tremor, nausea, and heart palpitations. A person who is suffering from delirium tremens will also appear extremely anxious, agitated, and confused. The person may experience hallucinations and appear completely out of touch with reality.

Additional delirium tremens symptoms, which can be especially severe, include seizures, dangerously high blood pressure, elevated body temperature, and coma. Patients with delirium tremens may also display psychotic behaviors and become aggressive, putting them at risk of harming themselves or others.

Unfortunately, the side effects of delirium tremens can be fatal. For example, the symptoms of delirium tremens can cause heart attack, irregular heart rhythms, or aspiration pneumonia, all of which can be deadly. According to the report in Drugs, 1 to 5 percent of people who undergo delirium tremens will die.

Delirium Tremens Timeline

Delirium tremens is typically classified as one of the later alcohol withdrawal symptoms. According to the delirium tremens timeline in the journal Drugs, delirium tremens symptoms usually begin two to three days after a person stops drinking alcohol, but in some cases, they may not appear until 10 days after a person’s last drink. People may wonder, “How long does delirium tremens last?” Per experts, symptoms usually pass after five to seven days.

While full delirium tremens typically does not show up until two to three days after the last drink, seizures may be an earlier symptom on the delirium tremens timeline. Around 10 percent of people who experience alcohol withdrawal will have a seizure, most often a day or two after their last alcoholic beverage. In about a third of patients undergoing withdrawal, delirium tremens is a worsening of initial withdrawal seizures.

Delirium Tremens & Hallucinations

While delirium tremens can cause hallucinations, it is important to note that hallucinations alone are not a sign of delirium tremens. It is possible for a person who experiences alcohol withdrawal to have hallucinations, beginning a day after the last drink. In fact, about a quarter of people who suffer from alcohol withdrawal will hallucinate, which involves hearing, seeing, or feeling things that are not really there.

What differentiates simple withdrawal hallucinations from delirium tremens and hallucinations is that someone who has hallucinations without delirium tremens will recognize that the hallucinations are not real. The person will remain oriented and in touch with reality. On the contrary, a person who has hallucinates during the course of delirium tremens will appear extremely disoriented and may not recognize the hallucinations as being unreal.

Risk Factors for Delirium Tremens

Since delirium tremens is extremely disorienting, potentially fatal, and can lead to serious complications if untreated, professionals will typically conduct an assessment to determine a person’s risk for developing delirium tremens during the course of alcohol withdrawal. First, addiction professionals will use a tool like the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) to rate the severity of a person’s withdrawal. A higher score on this assessment is indicative of severe withdrawal conditions like delirium tremens.

In addition to this assessment, a professional will evaluate whether a person demonstrates risk factors for delirium tremens. According to experts, a withdrawal score in the moderate to severe range on a withdrawal scale can indicate a risk of delirium tremens. Other risk factors for the condition include the following:

• Previous experience of alcohol withdrawal
• Use of other depressants, like benzodiazepine drugs
• Consumption of illegal drugs
• Elevated blood alcohol level
• High systolic blood pressure or body temperature
• Being of older age
• Medical problems
• Severe dependence upon alcohol
• Liver problems
• History of recent intoxication from alcohol
• Being male gender

Delirium Tremens Treatment

Since delirium tremens and death can be possible during alcohol withdrawal, someone who shows severe withdrawal symptoms or has significant risk factors for delirium tremens will require immediate medical treatment. Typically, treatment will occur in an inpatient or hospital setting, where medical staff can provide around-the-clock care and monitor patients for complications.

Medication is essential for treating delirium tremens and for preventing complications like coma, heart attack, and death. When administered early in the course of severe alcohol withdrawal, medication can even prevent a person from progressing to delirium tremens. As experts have explained, benzodiazepines are the drugs of choice for treating alcohol withdrawal, as they activate GABA receptors in the brain, much like alcohol does. These drugs have been shown to reduce the risk of delirium tremens and death.

Chlordiazepoxide and diazepam, commonly known by their brand names of Librium and Valium, respectively, tend to be the preferred benzodiazepine drugs for treating and preventing alcohol withdrawal conditions like delirium tremens, because they are long-acting and can make the withdrawal process more smooth. Experts recommend intravenous administration of benzodiazepines in severe cases of alcohol withdrawal, as the effects of the drug occur more quickly with this route of administration.

While the benzodiazepine drugs are preferred for treating delirium tremens, for some patients with severe cases of alcohol withdrawal, additional medications may be necessary to control symptoms. For example, a type of sedative drug called a barbiturate may be paired with benzodiazepines to treat severe delirium tremens. Some people may also be treated with a drug called propofol.

Ongoing Care after Delirium Tremens

After a person completes treatment for delirium tremens or other forms of alcohol withdrawal, it is important that he or she engage in ongoing psychological treatment to address the underlying issues that led to alcohol abuse and addiction. While withdrawal treatment is necessary to keep a person safe while detoxing from alcohol, it is only the first step in the recovery process.

With quality addiction treatment, a person can recover from alcohol abuse and reduce the risk of future withdrawal complications like delirium tremens. While not everyone who undergoes alcohol withdrawal will suffer from delirium tremens, it is a real risk for those who stop drinking after a period of heavy alcohol abuse. Given the fact that alcohol withdrawal can lead to delirium tremens and death, it is important that those who have been drinking heavily, especially for extended periods of time, consult with a medical or addiction treatment professional before giving up drinking. Some people may only experience mild withdrawal symptoms, but it is critical to be under the care of a professional when withdrawing from alcohol, especially since mild symptoms can progress to seizures and delirium tremens within a few days.

Sources & Additional Resources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085800/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978420/