Delirium tremens is a severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.
Alcohol abuse - delirium tremens; DTs; Alcohol withdrawal - delirium tremens; Alcohol withdrawal delirium
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 occurs most often in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints (1.8 to 2.4 liters) of wine, 7 to 8 pints (3.3 to 3.8 liters) of beer, or 1 pint (1/2 liter) of "hard" alcohol every day for several months. Delirium tremens also commonly affects people who have used alcohol for more than 10 years.
Symptoms most often occur within 48 to 96 hours after the last drink. But, they may occur 7 to 10 days after the last drink.
Symptoms may get worse quickly, and can include:
- Agitation, irritability
- Body tremors
- Changes in mental function
- Deep sleep that lasts for a day or longer
- Delirium, which is sudden severe confusion
- Excitement or fear
- Hallucinations (seeing or feeling things that are not really there)
- Bursts of energy
- Quick mood changes
- 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
- Insomnia (difficulty falling and staying asleep)
- Irritability or excitability
- Loss of appetite
- Nausea, vomiting
- Nervousness, jumpiness, shakiness, palpitations (sensation of feeling the heart beat)
- Pale skin
- Rapid emotional changes
- Sweating, especially on the palms of the hands or the face
Other symptoms that may occur:
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
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 person recovers from DT symptoms. This may involve:
- A "drying out" period, in which no alcohol is allowed
- Total and lifelong avoidance of alcohol (abstinence)
- 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
Attending a support group regularly is a key to recovering from alcohol use.
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
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
When to Contact a Medical Professional
Go to the emergency room or call 911 or the local emergency number if you have symptoms. Delirium tremens is an emergency condition.
If you go to the hospital for another reason, tell the providers if you've been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.
Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.
Kelly JF, Renner JA. Alcohol-related disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 26.
O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 30.