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Delirium tremens

DTs; Alcohol withdrawal - delirium tremens; Alcohol withdrawal delirium

 

Delirium tremens is a severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.

Causes

 

Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food.

Delirium tremens may also be caused by head injury, infection, or illness in people with a history of heavy alcohol use.

It is most common in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints of wine, 7 to 8 pints of beer, or 1 pint of "hard" alcohol every day for several months. Delirium tremens also commonly affects people who have used alcohol for more than 10 years.

 

Symptoms

 

Symptoms most often occur within 48 to 96 hours after the last drink. But, they can occur 7 to 10 days after the last drink.

Symptoms may get worse quickly, and can include:

  • Body tremors
  • Changes in mental function
  • Agitation, irritability
  • Confusion, disorientation
  • Decreased attention span
  • Deep sleep that lasts for a day or longer
  • Delirium
  • Excitement
  • Fear
  • Hallucinations (seeing or feeling things that are not really there)
  • Increased activity
  • Quick mood changes
  • Restlessness, excitement
  • Sensitivity to light, sound, touch
  • Stupor, sleepiness, fatigue

Seizures (may occur without other symptoms of DTs):

  • Most common in the first 12 to 48 hours after the last drink
  • Most common in people with past complications from alcohol withdrawal
  • Usually generalized tonic-clonic seizures

Symptoms of alcohol withdrawal, including:

  • Anxiety, depression
  • Fatigue
  • Headache
  • Insomnia (difficulty falling and staying asleep)
  • Irritability or excitability
  • Loss of appetite
  • Nausea, vomiting
  • Nervousness, jumpiness
  • Pale skin
  • Palpitations (sensation of feeling the heart beat)
  • Rapid emotional changes
  • Shakiness
  • Sweating, especially on the palms of the hands or the face

Other symptoms that may occur:

  • Chest pain
  • Fever
  • Stomach pain

 

Exams and Tests

 

Delirium tremens is a medical emergency.

The health care provider will perform a physical exam. Signs may include:

  • Heavy sweating
  • Increased startle reflex
  • Irregular heartbeat
  • Problems with eye muscle movement
  • Rapid heart rate
  • Rapid muscle tremors

The following tests may be done:

  • Blood magnesium level
  • Blood phosphate level
  • Comprehensive metabolic panel
  • Electrocardiogram (ECG)
  • Electroencephalogram (EEG)
  • Toxicology screen

 

Treatment

 

The goals of treatment are to:

  • Save the person's life
  • Relieve symptoms
  • Prevent complications

A hospital stay is needed. The health care team will regularly check:

  • Blood chemistry results, such as electrolyte levels
  • Body fluid levels
  • Vital signs (temperature, pulse, breathing rate, blood pressure)

While in the hospital, the person will receive medicines to:

  • Stay calm and relaxed (sedated) until the DTs are finished
  • Treat seizures, anxiety, or tremors
  • Treat mental disorders, if any

Long-term preventive treatment should begin after the patient recovers from DT symptoms. This may involve:

  • A "drying out" period, in which no alcohol is allowed
  • Total and lifelong avoidance of alcohol (abstinence)
  • Counseling
  • Going to support groups (such as Alcoholics Anonymous)

Treatment may be needed for other medical problems that can occur with alcohol use, including:

  • Alcoholic cardiomyopathy
  • Alcoholic liver disease
  • Alcoholic neuropathy
  • Wernicke-Korsakoff syndrome

 

Support Groups

 

Attending a support group regularly is a key to recovering from alcohol use.

 

Outlook (Prognosis)

 

Delirium tremens is serious and may be life-threatening. Some symptoms related to alcohol withdrawal may last for a year or more, including:

  • Emotional mood swings
  • Feeling tired
  • Sleeplessness

 

Possible Complications

 

Complications can include:

  • Injury from falls during seizures
  • Injury to self or others caused by mental state (confusion/delirium)
  • Irregular heartbeat, may be life threatening
  • Seizures

 

When to Contact a Medical Professional

 

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms. Delirium tremens is an emergency condition.

 

Prevention

 

Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.

 

 

References

Ferri, FF. Delirium tremens. In: Ferri FF, ed. Ferri's Clinical Advisor 2015. 1st ed. Philadelphia: PA Elsevier Mosby; 2015:p. 357.

O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.

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              Review Date: 2/8/2015

              Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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