What Is Delirium Tremens (DT)?

Delirium tremens, also known as DTs or alcohol withdrawal syndrome, is the most severe form of alcohol withdrawal and can be fatal if not appropriately managed. While people sometimes go through this process at home, it is common for those who want to quit drinking to withdraw and detoxify from alcohol at a medical facility.

Alcohol is a depressant, which slows down the central nervous system. Chronic, heavy alcohol use can change how the brain works, including how chemical messengers function. When alcohol consumption suddenly stops, the brain continues working in the state it has become used to, leading to symptoms of alcohol withdrawal. 

DTs typically begin after a person gives up alcohol following a binge or other period of heavy drinking, but they don't usually start immediately. A period of milder alcohol withdrawal often exists at first, with symptoms becoming increasingly more severe after 48 to 72 hours—although symptoms can begin as long as seven to 10 days after quitting drinking.

The delirium tremens experience can vary from one person to another, depending, in part, on the level of previous alcohol use. DTs are more common among people with a history of heavy, long-term alcohol consumption, and between 3% and 5% of people quitting alcohol will have delirium tremens symptoms.

Causes of Delirium Tremens

Delirium tremens can occur if you have a high alcohol intake, then reduce alcohol consumption quickly or suddenly stop drinking altogether. DTs are even more probable when food consumption is lower too.

People are are more likely to develop DT symptoms if they drink heavily over the span of several months (or years). That could mean:

• 4 to 5 pints of wine per day
• 7 to 8 pints of beer per day
• 1 pint of hard alcohol per day

Older people are at higher risk of increased blood alcohol levels, increasing their risk of withdrawal. This is due to decreases in liver function and brain neuron receptivity with age, in addition to also having reduced body water and body mass levels.

The risk of developing delirium tremens is higher if you've had alcohol withdrawal or delirium tremens in the past, or if you have a seizure disorder. If a person with heavy alcohol use has a head injury, infection, or illness, this can also contribute to DTs.

Delirium Tremens Symptoms

Delirium tremens symptoms can be both physical and psychological.

Physical Symptoms

Physical symptoms of delirium tremens can include:

• Chest pains
• Deep sleep lasting a day or more
• Energy bursts
• Fatigue
• Fever
• Headaches
• Heavy sweating
• Increased heart rate
• Increased startle reflex
• Involuntary muscle movements or contractions
• Loss of appetite
• Nausea
• Pale skin
• Seizures
• Sensitivity to light, sound, and touch
• Stomach pain
• Tremors or shakiness 

Psychological Symptoms

Along with physical symptoms, psychological symptoms are also common with DTs and can include:

• Anxiety
• Confusion
• Delirium 
• Delusions
• Depression
• Disorientation
• Excitement
• Fear
• Hallucinations
• Irritability
• Nervousness
• Nightmares
• Rapid mood changes
  

Diagnosis of Delirium Tremens

To diagnose delirium tremens, a healthcare provider considers medical history and symptoms and may conduct a physical exam. They will likely check for fever and dehydration, also listening to the heart to see if its beat is rapid or irregular.

Some healthcare providers administer an assessment known as the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) when diagnosing DTs. This assessment can help them gauge the nature and severity of symptoms.

Testing

A healthcare provider may conduct a variety of other tests to help diagnose delirium tremens, including:

• Blood magnesium test: This lab test checks the magnesium serum levels in the blood. Very low levels of magnesium can affect the ability of the heart to function normally and are a sign of alcohol use disorder or severe withdrawal.
• Electrocardiograph (ECG): This test looks at the electrical activity of the heart and can help doctors evaluate its function and condition.
• Electroencephalogram (EEG): This test evaluates electrical activity in the brain. Severe alcohol withdrawal can cause brain changes that may lead to seizures.
• Toxicology screen: This test measures how much alcohol is in the body and is usually performed by testing the blood or urine.

Treatment for Delirium Tremens

DTs are a medical emergency that requires hospitalization, as they can lead to potentially deadly cardiovascular issues.

DT treatment is focused on saving the individual's life first and foremost, followed by preventing complications and minimizing symptoms. This involves implementing both acute care (short-term) and long-term delirium tremens treatment strategies.

Acute Care

DT treatment may initially include the use of benzodiazepine medications to reduce the symptoms of alcohol withdrawal. Some of the medications used to treat delirium tremens include Ativan (lorazepam) and Librium (chlordiazepoxide). These medicines can help relieve the anxiety associated with severe, acute alcohol withdrawal.

Heavy alcohol use can also result in nutritional deficiencies. So when starting DT treatment, a healthcare provider may also recommend vitamins and mineral supplements, such as thiamine, zinc, phosphate, magnesium, and folate. 

Long-Term Treatment

Once health and safety have been addressed, treatment may then focus on long-term approaches to aid in recovery from alcohol dependence. These treatments can include group therapy, cognitive behavioral therapy (CBT), and sobriety support groups.

If you need help to stop drinking, there are resources that can help you. Groups such as Alcoholics Anonymous and Al-Anon can provide information and offer social support as you go through this process. You can even attend meetings online.

Complications

In addition to delirium tremens, heavy alcohol use can cause other complications that also require treatment. Among them are:

• Alcohol-related liver disease: Cirrhosis and scarring of the liver that can lead to liver disease and failure
• Alcoholic cardiomyopathy: Heart failure caused by stretching and drooping of the heart muscle
• Alcoholic neuropathy: Nerve damage caused by excessive drinking, potentially from a combination of poisoning the nerves and poor nutrition
• Wernicke-Korsakoff syndrome: Rare disorder resulting from a vitamin B1 deficiency; leads to permanent damage in certain areas of the brain, including the hypothalamus and thalamus, and occurs in 1% to 2% of the population

Other health problems that can occur from long-term, excessive alcohol use include stroke, digestive problems, cancer, mental health problems (such as depression), and weakening of the immune system.

Coping With Delirium Tremens

Alcohol withdrawal can be both unpredictable and dangerous, making medical help necessary for a safer recovery—particularly when DT symptoms are present. That said, there are still a few steps you can take to better cope with withdrawal symptoms and promote recovery. They include:

• Getting enough sleep
• Having adequate nutritious food and drink in your diet
• Paying attention to your personal hygiene
• Staying in an environment that is free from alcohol and other drugs