Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or neurological changes.
DT's; Alcohol withdrawal - delirium tremens
Delirium tremens can occur after a period of heavy alcohol drinking, especially when the person does not eat enough food.
It may also be triggered by head injury, infection, or illness in people with a history of heavy alcohol use.
It is most common in people who have a history of alcohol withdrawal. It is especially common in those who drink the equivalent of 4 - 5 pints of wine or 7 - 8 pints of beer (or 1 pint of "hard" alcohol) every day for several months. Delirium tremens also commonly affects those who have had a history of habitual alcohol use or alcoholism for more than 10 years.
Symptoms most commonly occur within 72 hours after the last drink, but may occur up to 7 - 10 days after the last drink. Symptoms may get worse rapidly, and can include:
Additional symptoms that may occur:
Delirium tremens is a medical emergency.
The health care provider will perform a physical exam. Signs may include:
The following tests may be done:
The goals of treatment are to:
A hospital stay is required. The health care team will regularly check:
Symptoms such as seizures and heart arrhythmias are treated with the following medications:
The patient may need to be put into a sedated state for a week or more until withdrawal is complete. Benzodiazepine medications such as diazepam or lorazepam are often used. These drugs also help treat seizures, anxiety, and tremors.
Antipsychotic medications such as haloperidol may sometimes be necessary for persons with hallucinations.
Long-term preventive treatment should begin after the patient recovers from acute symptoms. This may involve a "drying out" period, in which no alcohol is allowed. Total and lifelong abstinence is recommended for most people who go through withdrawal. The person should receive treatment for alcohol use or alcoholism, including:
The patient should be tested, and if necessary, treated for other medical problems associated with alcohol use. Such problems may include:
For additional resources, see alcoholism support group.
Delirium tremens is serious and may be life threatening. Symptoms such as sleeplessness, feeling tired, and emotional instability may persist for a year or more.
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms. Delirium tremens is an emergency condition.
Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.
For more information, see: Alcoholism
O’Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.