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Delirium Tremens

(DTs)

Definition

Delirium tremens (DTs) is a severe disturbance of the brain caused by alcohol withdrawal.
Adult Brain
Brain Man Face
The sudden withdrawal or decrease of alcohol can cause severe disturbances in the brain.
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Causes

DTs occur when a person who repeatedly drinks large amounts of alcohol suddenly stops or decreases the amount of alcohol consumed.

Risk Factors

These factors increase your chance of developing DTs:
  • History of DTs
  • Other medical problems in addition to alcohol abuse
  • Brain damage
  • Age: Older than 30 years

Symptoms

Symptoms usually begin 2-4 days after suddenly stopping or decreasing alcohol intake. Symptoms may include:
  • Anxiety
  • Confusion / disorientation
  • Delirium —changing levels of alertness
  • Trouble sleeping
  • Bad dreams
  • Severe agitation
  • Fever
  • Hallucinations—the perception of a thing, voice, or person that is not present, both visual and auditory
  • Delusions—a false belief that is strongly held
  • Tremors of the hands, head, or body
  • Severe sweating
  • Rapid heartbeat
  • Nausea
  • Increased rate of breathing
  • Increased blood pressure
  • Increased body temperature
  • Seizures
In severe cases, DTs can result in death, especially if untreated.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis of DTs is usually based on the symptoms and signs of the disorder. Tests may include:
  • You may have your bodily fluid tested. This can be done with blood tests to measure liver function, blood clotting ability, or electrolytes.
  • You may need to have your brain function evaluated. This can be done with electroencephalogram (EEG).
  • You may need to have pictures taken of your bodily structures. This can be done with:

Treatment

Treatment can be difficult. DTs are likely to last for 5-7 days. Clearing of DTs may begin in 12-24 hours, but may take up to 2-10 days. Treatment for alcohol abuse is necessary after DTs are under control.
Treatment may include:

Medication

Medicines may include:
  • Sedatives to:
    • Calm agitation
    • Ease withdrawal symptoms
  • Aspirin or acetaminophen to lower fever
  • Anti-seizure medicine

Vitamins and Fluids

Severe, life-threatening vitamin deficiency or dehydration may accompany DTs. Treatment may include:

Rehabilitation

Treatment for alcohol abuse may be done in a hospital setting or while living at home. It may involve individual or group therapy . Many people seek support by participating in groups, like Alcoholics Anonymous (AA).
If you are diagnosed as experiencing DTs, follow your doctor's instructions .
If you are diagnosed as experiencing DTs, follow your doctor's instructions .

Prevention

To prevent having DTs, do not abuse alcohol. If you do drink large amounts on a regular basis, do not suddenly decrease the amount or stop drinking on your own. Rather, get advice from your doctor on the safest way to lower your intake.

RESOURCES

Alcoholics Anonymous http://www.alcoholics-anonymous.org

National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov

CANADIAN RESOURCES

Alcoholics Anonymous http://www.aacanada.com

Canadian Centre on Substance Abuse http://www.ccsa.ca

References

Alcohol withdrawal. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 29, 2012. Accessed February 21, 2013.

Barrons R, Roberts N. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. J Clin Pharm Ther . 2010;35(2):153-67.

Berkow R. The Merck Manual of Medical Information . New York, NY: Simon and Schuster, Inc; 2000.

Braunwald E. Harrison's Principles of Internal Medicine . 15th ed. New York, NY: McGraw-Hill Professional Publishing; 2001.

McKeon A, Frye MA, Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psych. 2008;79:854-862.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 03/2013 -
  • Update Date: 00/31/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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