What Are Delirium Tremens?

May 1, 2024

Understanding Delirium Tremens

Let's delve into the details of delirium tremens to gain a more comprehensive understanding of this severe health condition associated with alcohol withdrawal.

Definition and Causes

Delirium tremens, also known as DT, is a severe form of alcohol withdrawal that involves sudden and significant changes in the mental or nervous system. This condition commonly affects individuals who have used alcohol for over a decade, particularly those who have a history of alcohol withdrawal and have consumed large amounts of alcohol daily for several months.

The only cause of delirium tremens is withdrawal resulting from sudden cessation of alcohol intake in individuals with alcohol use disorder. Delirium tremens can occur as early as 48 hours after abrupt cessation of alcohol and can last up to five days. Symptoms usually appear between one and three days after the last drink and peak four to five days after the last drink.

Risk Factors

Several risk factors can increase the likelihood of a person developing delirium tremens. These include a past history of DT, low platelet count, low potassium level, high blood homocysteine, low pyridoxine, the presence of a structural brain lesion, the presence of withdrawal seizures, somatic co-morbidities, and the severity of early alcohol withdrawal syndrome. Contrarily, factors such as gender, the presence of liver disease, and drinking patterns do not hold any predictive value for the development of DT [3].

This severe spectrum of alcohol withdrawal requires prompt and adequate management. If not treated, delirium tremens could potentially lead to death. Despite being less common in the general population, the prevalence of DT is higher among patients with alcohol dependence. However, only a minority of patients with alcohol use disorders would require medical attention for severe alcohol withdrawal syndrome with DT [3]. It's crucial to be aware of these risk factors and seek immediate medical help if symptoms of delirium tremens start to appear.

Symptoms of Delirium Tremens

Understanding the symptoms is key when answering "what are delirium tremens?". This severe form of alcohol withdrawal can be life-threatening and necessitates immediate medical attention.

Onset and Duration

Delirium tremens (DTs) is a disorder that can occur as early as 48 hours after sudden cessation of alcohol in individuals with chronic use. The symptoms can last up to five days, but in some cases, they can persist for up to seven days or even two weeks [2]. It's important to note that without appropriate treatment, the anticipated mortality of DTs can be as high as 37%.

Onset Duration Mortality without Treatment
48 hours after alcohol cessation Up to 5-7 days, can persist for 2 weeks in some cases Up to 37%

Clinical Presentation

The clinical presentation of DTs is often dramatic and can be distressing for both the individual and their caregivers. The main symptoms include visual hallucinations, profound confusion, tachycardia (rapid heart rate), hypertension (high blood pressure), hyperthermia (elevated body temperature), agitation, and diaphoresis (excessive sweating).

The visual hallucinations can be particularly disturbing and may involve seeing bugs or snakes. The agitation can lead to restlessness and an inability to stay calm or still. It's crucial to seek immediate medical care and treatment for DTs due to the possible risk of death.

Symptoms of Delirium Tremens
Visual hallucinations
Profound confusion
Tachycardia (rapid heart rate)
Hypertension (high blood pressure)
Hyperthermia (elevated body temperature)
Diaphoresis (excessive sweating)

Treatment of Delirium Tremens

Handling delirium tremens requires a carefully managed approach due to its severe nature and potential complications. This often involves immediate hospitalization and the use of specific medications.

Medical Emergency

Delirium tremens is recognized as a medical emergency that typically necessitates a hospital stay [1]. Immediate medical attention is required due to the severity of the symptoms and the potential risk of complications. Early recognition and treatment have significantly decreased the mortality rate to less than 5%.

The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is widely used to assess the severity of alcohol withdrawal. A score of 15 or greater corresponds to severe withdrawal symptoms, indicating a higher risk for seizures and delirium tremens.

Medications and Interventions

In terms of medications for managing delirium tremens, benzodiazepines are commonly used, with lorazepam, diazepam, and chlordiazepoxide being key examples. These can be administered on a symptom-triggered basis or a fixed schedule, depending on the patient's status.

For severe cases of delirium tremens that do not respond to benzodiazepines, other treatments may be used. These could include barbiturates like phenobarbital in combination with benzodiazepines or propofol in combination with benzodiazepines [2].

The primary goals of treatment for alcohol withdrawal and delirium tremens are to control agitation, diminish the risk of seizures, and decrease morbidity and mortality. It's crucial to remember that while these treatments can manage the symptoms, they do not address the underlying problem of alcohol dependence. Long-term treatment and support are often necessary to help individuals recover from alcohol use disorder.

Complications and Mortality

One of the most serious complications of alcohol withdrawal, delirium tremens (DT), is a potentially life-threatening condition. Understanding the potential risks and survival rates associated with this condition can provide insight into its severity and the importance of early intervention.

Potential Risks

Delirium Tremens, which falls in the most severe spectrum of alcohol withdrawal, could potentially result in death unless managed promptly and adequately. It presents with a combination of severe alcohol withdrawal symptoms and symptoms of delirium with agitation, and sometimes hallucination [3].

The condition is also associated with severe complications such as rhabdomyolysis, a breakdown of muscle tissue that can lead to kidney damage, and cardiac arrhythmias, irregular heart rhythms that can be life-threatening. Other potential risks include complications of withdrawal seizures or concomitant medical disorders.

Risk factors for DT include a past history of DT, low platelet count, low potassium level, high blood homocysteine, low pyridoxine, presence of structural brain lesions, severity of early alcohol withdrawal syndrome, older age, and low magnesium level. Gender, presence of liver disease, and drinking patterns do not have any predictive value.

Survival Rates

Without treatment, approximately 15% of people with delirium tremens do not survive. However, with early recognition and treatment, the survival rate can be increased to about 95%.

The mortality rate of DT has been decreased to less than 5% with early recognition and treatment. The usual causes of death in DT are hyperthermia, cardiac arrhythmias, complications of withdrawal seizures, or concomitant medical disorders [3].

DT is a short-lasting condition with a usual duration of 3–4 days (but might last for even 8 days) and it classically ends with a prolonged sleep. The current mortality ranges from 1 to 4%, which can be further reduced by effective and timely intervention. Patients with a history of DT have higher mortality (than those with only alcohol dependence and no DT) even longitudinally.

The high survival rates associated with early treatment underscore the importance of recognizing the symptoms of delirium tremens and seeking medical assistance as soon as possible. Early intervention can significantly improve the outcome and reduce the risk of serious complications.

Alcohol Withdrawal and Delirium Tremens

Closely intertwined with the topic of delirium tremens is the broader issue of alcohol withdrawal. This section will delve into the intricacies of Alcohol Use Disorder and the symptoms that manifest during alcohol withdrawal, which can potentially progress to delirium tremens.

Alcohol Use Disorder

Alcohol Use Disorder (AUD) is a common condition, with about 29% of adults in the U.S. meeting the criteria for it at some point in their lifetime. Approximately 1% to 1.5% of those individuals will experience delirium tremens. The only cause of delirium tremens is withdrawal resulting from sudden cessation of alcohol intake in individuals with AUD.

AUD is characterized by an individual's inability to stop or control alcohol use despite adverse social, occupational, or health consequences. It's also associated with an increased tolerance to alcohol and the presence of withdrawal symptoms when alcohol use is abruptly discontinued.

Alcohol Withdrawal Symptoms

Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol regularly stops drinking or significantly reduces their alcohol consumption. These symptoms can vary from mild to severe, and can include tremors, anxiety, nausea, and insomnia.

Delirium tremens is a severe form of alcohol withdrawal that can occur in individuals with a history of heavy alcohol use. The symptoms of delirium tremens usually occur within 48 to 96 hours after the last drink, but they may also manifest 7 to 10 days after the last drink. These symptoms can escalate quickly and may include seizures, hallucinations, and severe changes in mental function.

The onset of delirium tremens can also occur between one and three days after the last drink, with symptoms peaking four to five days after the last drink [4].

Without appropriate treatment, delirium tremens can last up to seven days, with some individuals experiencing symptoms for up to two weeks [4]. The condition is considered a medical emergency and requires immediate medical attention.

Recognizing the signs of alcohol withdrawal and understanding the risk of delirium tremens is crucial in seeking timely treatment and preventing serious health complications. It's equally important for individuals with AUD to seek professional help in managing their condition. Effective treatment strategies are available, and complete avoidance of alcohol (abstinence) is recommended as the safest approach for those with a drinking problem.

Global Impact of Alcohol Use

The consumption of alcohol has a significant impact on global health, contributing to numerous deaths and health complications each year. This section will discuss the mortality rate associated with alcohol use and the health consequences resulting from heavy drinking.

Alcohol-Related Deaths

According to the Global Status Report on Alcohol and Health published in 2014, alcohol consumption is responsible for around 3.3 million deaths annually, which accounts for 5.9% of global mortality. This figure surpasses the death rate due to HIV/AIDS, tuberculosis, and violence combined, indicating the severe impact of alcohol use on global health.

Due to its widespread use, alcohol is a major contributor to disease and mortality worldwide. More than one third of the world's population (38.3%) can be categorized as current drinkers, further highlighting the global prevalence of alcohol use.

Alcohol Impact Statistics
Global Mortality Rate 5.9%
Disability Adjusted Life Years (DALY) 5.1%
Percentage of Global Population as Current Drinkers 38.3%

Health Consequences

Alcohol use is not only associated with a high mortality rate, but it also contributes to a significant portion of health complications. The report further establishes that alcohol use accounts for 20-50% of several health conditions, including cirrhosis of the liver, poisonings, epilepsy, road side accidents, several types of cancer, and violence.

These health consequences, combined with the high mortality rate, underscore the negative impact of alcohol use on global health. It's important to promote awareness of these risks and encourage responsible drinking habits to mitigate these effects.

Health Conditions Contribution from Alcohol Use
Cirrhosis of the Liver 20-50%
Poisonings 20-50%
Epilepsy 20-50%
Roadside Accidents 20-50%
Various Types of Cancer 20-50%
Violence 20-50%

These figures demonstrate the substantial impact of alcohol use on global health and mortality, emphasizing the importance of alcohol abuse prevention and treatment. Understanding the connection between alcohol use and health complications, including delirium tremens, is crucial in mitigating these risks.


[1]: https://medlineplus.gov/ency/article/000766.htm

[2]: https://www.ncbi.nlm.nih.gov/books/NBK482134/

[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286444/

[4]: https://my.clevelandclinic.org/health/diseases/25052-delirium-tremens

[5]: https://www.webmd.com/mental-health/addiction/delirium-tremens

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