Delirium Tremens (DTs) | Symptoms, Causes, & Treatment For Alcohol Withdrawal Delirium

When heavy alcohol use is decreased or suddenly stopped, it can cause alcohol withdrawal symptoms. Untreated alcohol withdrawal can progress into a severe condition known as delirium tremens. 

Delirium tremens (DTs), also referred to as alcohol withdrawal delirium, may be life-threatening and require immediate medical attention. DTs can cause severe mental and nervous system changes, including confusion and seizures. 

What Are Delirium Tremens?

Delirium tremens are a severe form of alcohol withdrawal, characterized by confusion and autonomic hyperactivity. Autonomic hyperactivity means an increase in anxiety, fear, and heart palpitations. 

Delirium tremens can also trigger seizures, visual hallucinations, and several other serious symptoms. The symptoms of DTs can be life-threatening and are considered a medical emergency. 

Symptoms Of Delirium Tremens

Symptoms of acute alcohol withdrawal may begin about 6 hours after the last drink. These symptoms can be mild or severe. 

Symptoms of alcohol withdrawal may include:

• tremors
• anxiety
• insomnia
• nausea
• rapid breathing
• sweating
• fever

After the onset of acute alcohol withdrawal, some people may experience more severe symptoms. These symptoms are known as delirium tremens. 

Symptoms of delirium tremens can begin 2-4 days after the last drink and may persist for 3-4 days. 

Symptoms of DTs include: 

• severe confusion and disorientation
• irregular heartbeat
• sweating
• tremors
• decreased mental function
• mood changes, including irritability 
• deep sleep for at least 24 hours
• fear
• hallucinations
• restlessness
• sensitivity to light, sound, or touch
• fatigue
• grand mal seizures

Delirium, or severe confusion, can lead to dangerous behaviors that put the individual and people around them at risk. In addition, alcohol withdrawal seizures can cause a loss of consciousness and violent muscle contractions. 

If you recognize symptoms of delirium tremens in yourself or a loved one, seek medical care immediately.

What Causes Delirium Tremens?

About half of all people who abuse alcohol in their lifetime are likely to experience alcohol withdrawal syndrome. Of those who experience alcohol withdrawal, 3 to 5 percent experience severe alcohol withdrawal or DTs. 

Delirium tremens usually affect people who have a long history of daily or heavy drinking. When someone stops drinking suddenly or cuts back on alcohol use too quickly, they increase the risk of DTs. 

Along with alcohol abuse, the following are risk factors for delirium tremens:

• history of seizures
• medical problems (such as a head injury or infection)
• reducing or stopping alcohol use abruptly
• not eating enough 
• history of alcohol detoxification

If you or someone you love wants to stop drinking, it is not recommended to quit cold turkey. Instead, a medical detox program can manage withdrawal symptoms and monitor for DTs and other severe withdrawal symptoms. 

Alcohol Withdrawal Delirium Treatment

Between 5 and 15 percent of delirium tremens cases are fatal. However, early and adequate treatment significantly decreases the risk of death. 

Along with fatalities, delirium tremens are also associated with respiratory depression, seizures, and irregular heartbeat. Inpatient medical treatment is necessary to treat symptoms and lower the risk of medical complications from DTs.  

During treatment for DTs, healthcare professionals will monitor:

• electrolyte levels
• heart rate
• body fluid levels
• body temperature 
• pulse
• breathing rate
• blood pressure

Medications

To decrease anxiety, agitation, and the risk of seizures, sedative medication is often administered through an intravenous (IV) route. The most common type of medication to treat DTs is benzodiazepines but in some cases, barbiturates may also be used. 

The following medications are commonly used to treat DTs:

• Ativan (lorazepam)
• Valium (diazepam)
• Librium (chlordiazepoxide)
• Luminal (phenobarbital)

People who drink heavily may not get adequate nutrition and hydration, which can lead to vitamin deficiencies. Multivitamins and vitamin B1 (thiamine) are often given during detoxification to prevent health complications. 

Alcohol Use Disorder Treatment

It is important to abstain from further alcohol use once symptoms subside if you have an alcohol use disorder (AUD). An AUD means you cannot control the amount you drink, even if drinking negatively affects your life. 

Even after detoxification, you may still experience cravings, anxiety, trouble focusing, and other difficulties. If you have experienced alcohol dependence, alcohol withdrawal, or DTs and have an AUD, you may benefit from comprehensive treatment.

Inpatient treatment centers offer a wide range of services that can teach you life skills to help you cope without alcohol and improve your quality of life. 

An addiction specialist can help you develop a personalized treatment plan. Depending on your needs, you may have access to the following services:

• behavioral therapy
• group therapy
• individual counseling
• healthy activities, like yoga or meditation
• support groups, like Alcoholics Anonymous

If you or a loved one is struggling with alcohol abuse or an alcohol use disorder, Ark Behavioral Health can help. Reach out to us today to speak with a specialist about treatment options.