Delirium Tremen: About, Signs, Symptoms & Treatment

Alcohol-addicted individuals who are trying to quit their dependency need to go through the detoxification process before starting treatment. The detox stage involves cessation of alcohol consumption to completely rid the body of all traces of alcohol.

Completely ceasing the intake of alcohol is a non-issue for occasional drinkers but for people who abuse alcohol, the detox process can cause alcohol withdrawal. Symptoms of withdrawal can be as mild as vomiting, sweating, and headache, among others. For people with severe alcohol use disorder, however, abruptly stopping alcohol use can lead to a harsh form of alcohol withdrawal known as delirium tremens.

What is Delirium Tremens?  

Delirium Tremens (DTs) is a form of severe alcohol withdrawal. It is generally characterized by sudden and extreme confusion, autonomic hyperactivity, and even cardiac arrest. Delirium tremens meaning “trembling delirium” in the literal sense, was first acknowledged as far back as 1813 as a delirium related to the severe abuse of alcohol.  This condition was named and initially discussed by Kent Physician Thomas Sutton who published the book, “Tracts on Delirium Tremens, on Peritonitis, and on Some Other Internal Inflammatory Affections, and on the Gout.”

While over 50 percent of people with a history of abusing alcohol manifest symptoms of alcohol withdrawal, only 5 percent or less have been found to exhibit symptoms of delirium tremens.  DTs has been found most rampant among individuals with prior history of alcohol withdrawal and those who consume alcoholic drinks in the following amounts daily for several months:

• 3.3 to 3.8 liters of beer;

• 1.8 to 2.4 liters of wine; or

• Half a liter of “hard” alcohol

Other factors that may increase the likelihood of experiencing delirium tremens also include prior history of delirium tremens and/or seizures and detox, concurrent medical condition, heavy and prolonged alcohol intake, and presence of structural lesions in the brain, among others.

What is Delirium Tremens Symptoms?  

Alcohol-addicted individuals who are suffering from delirium tremens commonly experience the following signs and symptoms:

• Nausea

• Body tremors

• Sweating

• Elevated blood pressure

• Tachycardia (a resting heart rate of more than a hundred beats per minute)

• Severe anxiety

• Intense feelings of fear or paranoia

• Hallucinations (seeing or hearing things that are not real)

• Delirium or serious disruption of mental abilities

• Confusion

• Rapid change in mood

• Sleep disturbance

• Agitation

• Sensitivity to touch, light, and sound

DTs from drinking beer and other alcoholic drink excessively can also cause seizures even with the absence of the other symptoms mentioned above.

How Long Does Delirium Tremens Last?  

The symptoms of delirium tremens usually manifest and peak within 2 to 4 days after the last alcohol consumption.  In some instances, however, alcohol-dependent individuals may experience symptoms of DTs up to a week to 10 days after sudden cessation of alcohol.

Alcohol withdrawal symptoms typically progress in the following way:

• Within 6 to 24 hours after the alcoholic’s last drink – minor alcohol withdrawal occurs characterized by less severe symptoms like nausea, vomiting, and insomnia.

• Within 10 to 72 hours after the alcoholic’s last drink – major alcohol withdrawal symptoms manifest such as hallucinations (visual, auditory, and tactile), body tremor, high blood pressure, and excessive sweating.

• Within 72 to 240 hours (3 to 10 days) after the alcoholic’s last drink – this is when the most serious signs of delirium tremens manifest such as disorientation, hallucinations, confusion, irregular heartbeat, and hypertension, among others.

How is Delirium Tremens Evaluated?  

The occurrence of delirium tremens is evaluated by a health care practitioner through the conduct of physical exam and administration of medical tests.  For the physical exam, the medical practitioner will be on the lookout for the following signs:

• Excessive sweating

• Increased startle response

• Abnormal heartbeat

• Eye muscle movement issues

• Rapid muscle movement (tremors)

The patient may also undergo the following clinical tests:

• Electrocardiogram (ECG)

• Electroencephalogram (EEG)

• Magnesium blood test

• Phosphorus blood test

• Comprehensive metabolic panel blood tests

• Toxicology screening

How is Delirium Tremens Treated?  

Regardless of the many delirium tremens stories by patients, you may have read on the internet, delirium tremens treatment at home is generally not advisable. DTs is a medical emergency that requires immediate hospitalization.  Note that despite appropriate treatment interventions, delirium tremens deathrate still ranges between 5 percent to 15 percent.

The goals of treatment for delirium tremens include the following:

• Save the alcohol-addicted person’s life

• Alleviate the symptoms of DTs

• Deter the onset of further complications

During hospital confinement, the patient’s temperature, blood pressure, and other vital signs, results of blood chemistry, and levels of body fluid shall be regularly checked and monitored by the medical team.  He will also receive medications such as the benzodiazepines barbiturates, or lorazepam to:

• Keep him calm until the symptoms end

• Address his anxiety, tremors or seizures

• Address mental health issues should they occur

Once the patient recovers from the life-threatening symptoms of delirium tremens, preventive treatment strategies like the following begin to maintain long-term sobriety:

• Counseling

• Cognitive Behavior Therapy

• Participation in meetings and activities of alcohol support groups like the Alcoholics Anonymous

How to Prevent Delirium Tremens?  

Considering that the primary cause of delirium tremens is excessive alcohol consumption, the most effective way to prevent its occurrence is by immediately addressing alcohol use disorder. If alcohol dependence is recognized and treated before it becomes a serious and recurring problem, severe withdrawal symptoms can be evaded.

Young adults who are starting to experiment and engage in frequent drinking sessions should be immediately dealt with.  Their families and significant others should help them seek appropriate interventions to help address the drinking problem early on.

For heavy alcohol drinkers visiting a hospital or other medical facilities, honesty is key. They should disclose their drinking habit to the doctor or medical practitioner helping them even if they are in the hospital for some other reason.  This way, the doctor can monitor and readily address early signs of alcohol withdrawal should they occur.

Do you still have questions or concerns about Delirium Tremens?  If so, we are here to help.  Contact us today to get all of your questions answered.