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Understanding Delirium Tremens (DTs): Causes, symptoms and treatment

Team AckoJun 23, 2024

Abruptly quitting alcohol can trigger withdrawal symptoms, including Delirium Tremens (DTs), a potentially fatal condition. Identifying early signs such as agitation, tremors, hallucinations, and confusion is crucial. Without timely intervention, Delirium Tremens can escalate, leading to withdrawal seizures, cardiovascular instability, and even death. Seeking medical assistance for safe detoxification and management of withdrawal symptoms is imperative to ensure the individual's well-being during alcohol cessation. Professional guidance and support can mitigate risks and facilitate a smoother transition towards sobriety, promoting long-term health and recovery. Read on to know the symptoms, causes, treatment, and prevention methods of this condition.

Delirium

Contents

What is Delirium Tremens?

Delirium Tremens (DTs) is a potentially severe condition that can occur when a person suddenly stops alcohol intake after drinking heavily for a long period of time. It is also known as alcohol withdrawal delirium (AWD). It typically occurs within 2 to 3 days after a person stops drinking. It lasts for 2 to 3 days, but a person may experience a few signs that may extend for a week.

Symptoms of Delirium Tremens

Signs of Delirium Tremens may include the following.

Anxiety

Auditory or visual hallucinations

Body tremors

Agitation

Changes in blood pressure and heart rate

Severe confusion

Diarrhoea

Chest pain

Loss of appetite

Dehydration

Fatigue

Fever

Rapid emotional change

Sensitivity to touch, light, and sound

Heavy sweating

Deep sleep that lasts for a day or longer

Hallucinations

Headache

Nausea

Vomiting

Nightmares

Bursts of energy

Pale skin

Trouble breathing

These signs may get worse quickly. So, timely action is required to start the treatment.

Causes of Delirium Tremens

It is common among people who are heavy drinkers. For men, heavy drinking is 15 drinks a week. For women, it is 8 or more drinks per week.

Those who are long-term drinkers (for more than 10 years) usually face this problem. However, this condition is most common in those who have gone through alcohol withdrawal before. Apart from these, people who have a history of seizures experience it as well. It can also be caused by a head injury or infection.

Delirium Tremens Timeline and Stages

Delirium Tremens (DTs) marks the severe end of Alcohol Withdrawal Syndrome (AWS), a condition experienced by individuals who abruptly cease or significantly reduce their alcohol consumption. The timeline and stages of DTs are crucial for understanding its progression and severity.

Stage 1 of AWS typically manifests within 8 to 24 hours after the last drink. Symptoms include insomnia, headaches, increased anxiety, restlessness, tremors, and gastrointestinal upset. These symptoms are discomforting but generally manageable.

Stage 2 occurs around 48 to 72 hours after the last drink. This stage presents moderate withdrawal symptoms such as sweating, nausea, vomiting, increased heart rate, elevated blood pressure, and palpitations. Additionally, hallucinations, both auditory and visual, can manifest between 12 to 24 hours after the last drink and often accompany the initial mild symptoms.

Delirium Tremens, classified as Stage 3 of AWS, emerges in severe cases and typically arises 2 to 4 days after the last alcoholic beverage, although it can sometimes occur later, up to 7 to 10 days post-drinking cessation. DTs is characterised by a constellation of severe symptoms that can be life-threatening if left untreated.

Symptoms of DTs include profound confusion, disorientation, agitation, hallucinations (both visual and auditory), severe tremors, seizures, hyperactivity, autonomic instability (such as fluctuations in blood pressure, heart rate, and temperature), and, in some cases, coma. Individuals experiencing DTs may also exhibit delusions, paranoia, and extreme sensitivity to stimuli.

The duration of DTs symptoms can vary, but they may persist for up to five days. DTs requires immediate medical intervention due to its potential for severe complications, including cardiovascular collapse, respiratory failure, and death.

Complications of Delirium Tremens

Alcohol use affects the nervous system, which slows down the brain's functioning. The brain adapts to the process of consuming alcohol, and eventually the individual develops a dependency on alcohol. When the individual stops or reduces alcohol intake, the brain gets overstimulated. This causes a state when the body starts showing signs of alcohol withdrawal. If the symptoms become severe, then the condition may lead to other complications, which are as follows.

1. Alcoholic cardiomyopathy

In this condition, the heart changes its shape and leads to severe problems. It also causes hearing loss as a result of prolonged alcohol usage. If this condition can't be treated, a heart transplant would be an option.

2. Wernicke-Korsakoff syndrome

It is also called Korsakoff's amnesic syndrome. It is a brain condition that is linked to heavy drinking. It causes lasting damage to cells in the spinal cord and brain, including the memory-related part. A doctor will suggest vitamin B1 to treat muscle aches. But memory loss is usually permanent.

3. Alcohol-related liver disease

It is also called alcoholic fatty liver disease. It develops as a result of years of heavy drinking. It causes liver cirrhosis and scarring. Timely treatment is essential; otherwise, it will lead to renal failure and liver cancer.

4. Alcoholic neuropathy

It is referred to as "damage to the nerves" that is caused by heavy drinking and is a permanent condition. Painful sensations, tingling in the limbs, and reduced mobility are some of its signs.

Delirium Tremens diagnosis

The diagnosis of Delirium Tremens (DTs) is usually made based on a person's history and symptoms. Also, a doctor may conduct a physical exam and see if you have any signs, including the following.

Irregular heart rate

Hand tremors

Dehydration

Further, your doctor may perform a toxicology screen test, which shows the amount of alcohol present in your body. This screening test is done with a urine or blood sample. Apart from these, your doctor may order the following tests to assess the severity.

1. Blood phosphate level

It is evaluated in a blood test, and low levels of phosphate exhibit alcoholism.

2. Blood magnesium level or serum magnesium level

It's a quick blood test that is used to determine the blood magnesium level. Low magnesium levels are a sign of severe alcohol withdrawal.

3. Comprehensive metabolic panel

The abnormal result of this blood test is a clear indication of alcoholism. It also provides information about liver function, kidney function, and blood sugar levels.

4. EEG (electroencephalogram)

It measures the electrical activity in the brain and can be used to assess those facing serious alcohol withdrawals.

5. ECG (electrocardiograph)

It measures the electrical activity in the heart and can evaluate the severity of withdrawal.

6. Lumbar puncture test

It is used to examine or remove spinal cord fluid.

7. Metabolic panel

This test measures different substances in your blood, such as sodium, potassium, calcium, potassium, and more.

How Long Does Delirium Tremens Last?

Delirium Tremens (DTs) typically lasts five to seven days, with duration influenced by the duration and intensity of alcohol consumption. Seeking treatment promptly for alcohol use disorder or addiction reduces the risk of life-threatening withdrawal effects. Early intervention enhances prognosis and minimises DTs' severity.

If DTs symptoms arise, immediate medical assistance is imperative to mitigate risks. Prompt intervention ensures appropriate management and decreases the likelihood of complications, emphasising the critical importance of seeking help at the earliest signs of alcohol withdrawal.

Treatment of Delirium Tremens

Delirium Tremens is a serious and life-threatening condition that needs immediate medical attention. Treatment usually begins in the emergency room, where individuals are closely monitored around the clock.

Depending on the severity of the DTs, individuals may be treated with medication to help control the symptoms. Medications used to treat the condition may include the following.

Benzodiazepines

Antipsychotics

Pain medication

Drugs to regulate heartbeat

Anticonvulsants

Blood pressure medication

In severe cases, individuals may need to be intubated and placed on a ventilator to assist with breathing. Once the individual is stabilised, they will be transferred to a regular hospital room and monitored closely. Treatment for DTs often lasts for 3 to 5 days. During this time, the person will be given IV fluids and nutrients to help prevent dehydration.

The individual will also be monitored for any signs of relapse. If Delirium Tremens do occur, doctors will restart the treatment. The individual may need to be hospitalised for a week. After being discharged from the hospital, the individual will need to follow up with their doctor and continue treatment as directed. Treatment for Delirium Tremens may include medication, rehabilitation, lifestyle changes, and treatment for alcohol-related conditions.

It is vital to note that it is a medical emergency and can become fatal when left untreated. If you or someone you know is showing signs or symptoms of DTs, seek medical help immediately.

Coping With Delirium Tremens

Coping with DTs requires a comprehensive approach to ensure safety and promote recovery, with medical assistance being paramount. Despite the severity of DTs symptoms, individuals can take several steps to cope with withdrawal and support their well-being:

Prioritise Sleep

Getting enough rest is crucial during alcohol withdrawal. Establishing a regular sleep schedule and creating a comfortable sleep environment can aid in managing symptoms like insomnia and restlessness.

Maintain Nutrition

Consuming nutritious food and staying hydrated are essential for replenishing lost nutrients and supporting overall health during withdrawal. Focus on balanced meals and staying hydrated with water or electrolyte-rich beverages.

Personal Hygiene

Practising good personal hygiene can contribute to a sense of well-being and dignity during a challenging time. Regular grooming habits can help individuals feel more comfortable and confident as they navigate withdrawal symptoms.

Safe Environment

Ensure that the environment is free from alcohol and other drugs to minimise triggers and temptations. Surrounding oneself with supportive individuals who understand the importance of sobriety can also aid in recovery.

While these coping strategies can provide some relief, it's crucial to seek professional medical help for DTs symptoms. Medical professionals can offer appropriate interventions, such as medications, to manage symptoms and prevent complications, ensuring a safer and more effective recovery journey.

How to prevent Delirium Tremens

There are a few things you can do to lower your risk of contracting DTs or lessen the symptoms if you do develop this condition. You can count on the following ways.

Avoid drinking alcohol in large quantities and on an empty stomach.

If you are taking certain medications, you should avoid drinking alcohol.

Get enough rest and sleep.

Consume a healthy diet.

Drink plenty of fluids, especially water.

If you are experiencing alcohol withdrawal symptoms and have a higher risk of developing seizures, seek medical treatment without any delay.

Monitoring During Delirium Tremens Treatment

Monitoring during care for Delirium Tremens (DTs) is crucial for ensuring the safety and well-being of the individual undergoing withdrawal. This comprehensive monitoring regimen typically includes:

Continuous Pulse Oximetry

This method monitors blood oxygen levels continuously, providing valuable information about respiratory function and oxygenation.

Intermittent Blood Samples

Occasional blood samples may be taken to obtain more precise measurements of blood oxygen levels, helping healthcare providers assess respiratory status and detect any abnormalities.

Continuous Blood Pressure and Pulse Measurements

Regular monitoring of blood pressure and pulse rate helps identify any fluctuations or irregularities, guiding medical interventions as needed.

Electrocardiogram (EKG)

This non-invasive test records the heart's electrical activity, enabling the detection of arrhythmias or other cardiac abnormalities.

Breathing Rate Assessment

Monitoring breathing rate helps healthcare providers evaluate respiratory function and detect any signs of respiratory distress.

Frequently Asked Questions (FAQs)

Listed below are some of the common questions related to Delirium Tremens.

How long do DTs usually last?

It lasts for 24 hours to 6 days, and in rare cases, it can last for weeks.

How does Delirium Tremens lead to death?

This condition requires prompt care, and its short-term effects can be life-threatening. If left untreated, an individual may experience seizures, hallucinations, dehydration, and changes in blood pressure and heart rate. All these symptoms can be fatal.

Is Delirium Tremens a psychiatric emergency?

It is a medical emergency. Some individuals get discharged after the complete resolution of DTs, while others receive comprehensive in-patient addiction treatment, depending on the case.

Is Delirium Tremens reversible?

It is not a permanent condition, but it is life-threatening. Recovery of brain function is possible, but complete recovery can be harder. It totally depends on the individual’s case. If someone continues to drink after rehabilitation, then there are higher chances of experiencing DTs again in the future.

References

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.