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Delirium Tremens (DTs): Symptoms, Causes, Duration, and Treatment

Alcohol use is common in the United States, with slightly over half of adults indicating they had consumed an alcoholic beverage during the past month as of 2018. What is less common, however, is alcohol addiction and its consequences, as roughly 6 percent of adults in the United States have a diagnosable addiction called an alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism.

Ongoing alcohol abuse and addiction can lead to significant consequences, such as health problems, serious injuries, and difficulty functioning in work or family life. Another consequence of alcohol abuse is dependence, meaning that the body does not function well without alcohol. When a person who develops an alcohol dependence stops drinking, he or she will typically experience withdrawal. One serious form of withdrawal, called delirium tremens, can be fatal; however, proper medical care can prevent complications from delirium tremens and allow those living with alcohol addictions to participate in ongoing treatment to achieve lasting sobriety.

What is Delirium Tremens?

Delirium tremens is a complicated form of alcohol withdrawal. According to researchers writing for a 2015 publication of Drugs, as many as half of people with an alcohol use disorder will experience withdrawal if they suddenly stop or decrease their alcohol use. Common symptoms of withdrawal include tremors, agitation, and nausea.

What is Delirium Tremens

While mild forms of alcohol withdrawal do not typically require medical treatment, delirium tremens is a more severe presentation of withdrawal that necessitates medical intervention. A person who is suffering from delirium tremens will experience significant confusion, as well as psychosis, hallucinations, elevated body temperature, high blood pressure, seizures, and even coma. About five percent of those who experience alcohol withdrawal will develop delirium tremens.

The condition is potentially life threatening, as it can lead to medical complications, such as heart attack and pneumonia. The research shows that up to five percent of delirium tremens cases will be fatal. This is why proper medical care is critical.

What Causes Delirium Tremens?

When a person who is dependent upon alcohol stops drinking, there are changes in the nervous system that result in withdrawal symptoms. This is because the body adapts to alcohol use over time, but when alcohol is absent, chemicals in the nervous system become out of balance. For instance, when a person suddenly stops drinking, a brain chemical called glutamate becomes overactive. This chemical causes nerve cells to activate, and results in withdrawal symptoms. Delirium tremens is a severe manifestation of these physiological processes that occur during alcohol withdrawal.

Alcohol Dependence

While changes in the body’s physiology can cause delirium tremens, it is clear that not all cases of withdrawal lead to this serious condition. According to specialists from the Catholic University of Rome, SS Annunziata University, the University of Bologna, and the National Institutes of Health, delirium tremens is the result of poor treatment or lack of treatment for alcohol withdrawal symptoms. For instance, if a person begins to develop withdrawal seizures but receives no treatment, his or her condition may progress to delirium tremens. In fact, about one-third of patients who experience delirium tremens progress to this condition because of worsening withdrawal seizures.

In addition to lack of treatment and uncontrolled seizures, there are risk factors that can make delirium tremens more likely to occur. These include a history of the condition, as well as a history of kindling, which is a term used to describe the nervous system hyperactivity that occurs with repeated bouts of alcohol withdrawal.

Additional research has uncovered what type of alcohol consumption is most likely to cause delirium tremens. According to a 2019 Denmark study, those who consume spirits and who drink 20 or more alcoholic beverages per day are at an elevated risk of delirium tremens. Based upon this finding, it appears that heavy alcohol use, and particularly liquor consumption, can be among the causes of withdrawal that progresses to delirium tremens.

How Long Do Delirium Tremens Last?

How Long Do Delirium Tremens Last

According to the 2015 report in Drugs, delirium tremens typically begins two to three days after a person consumes his or her last alcoholic beverage.

Not every case begins this suddenly, as some cases do not show up for as many as 10 days after the last alcoholic drink. Once symptoms appear, they usually persist for five to seven days.

After the worst symptoms pass, some patients may experience some lingering alcohol withdrawal symptoms for weeks or even months, representing a situation that is called protracted withdrawal.

Treatment of Delirium Tremens

Regardless of its duration, delirium tremens is a serious and potentially life-threatening condition, so medical treatment is critical. As a medical doctor writing for The Hospitalist has explained, early withdrawal, which is a term used for less severe alcohol withdrawal symptoms like tremors, increased heart rate, and mild hallucinations, can resolve on its own without treatment, and not all patients will progress to late withdrawal, which is when delirium tremens occurs. That being said, those who do progress to delirium tremens are in need of alcohol detox and treatment in a hospital setting. For those who have a history of delirium tremens or a co-occurring medical or psychological condition, inpatient medically-assisted detox & treatment is the safest option.

Treatment of Delirium Tremens

Treatment typically involves benzodiazepine drugs, which are used to treat anxiety, seizures, and sleep problems. According to researchers writing for the Journal of Clinical and Experimental Hepatology, diazepam and lorazepam are typically the specific drugs of choice for treating delirium tremens. In cases where a patient does not respond to these drugs, alternative medications, such as phenobarbital may be used.

Within the course of treatment, there are typically other interventions necessary to restore health to a patient with delirium tremens. For example, the National Institute on Drug Abuse has reported that alcohol withdrawal often leads to dehydration, so those who suffer from delirium tremens may require treatment with IV fluids. In addition, supplementation with magnesium, folic acid, and thiamine may be warranted to address nutritional deficiencies and prevent complications. Medical staff in a hospital setting can provide around-the-clock care to monitor symptoms, ensure that patients remain safe, and address any changes in a patient’s medical status throughout the course of treatment.

Ongoing Alcoholism Treatment

Following treatment of severe and potentially fatal delirium tremens symptoms, patients who are recovering from alcohol withdrawal will require ongoing substance abuse treatment to remain abstinent. According to a study carried out by researchers affiliated with the National Institute of Mental Health and Neuro Sciences in India, patients who engaged in comprehensive addiction treatment after receiving emergency care for delirium tremens were less likely to relapse and more likely to regularly engage in outpatient services during a six-month follow-up period.

Ongoing Alcoholism Treatment

Patients in the study received inpatient addiction treatment after recovering from delirium tremens in an emergency setting, suggesting that this level of care may be necessary for those whose alcohol abuse is severe enough to cause delirium tremens. The overarching point of this finding is that to receive the full benefits of delirium tremens treatment and avoid future episodes, patients must engage in ongoing addiction care to address the underlying alcohol use disorder.

Delirium tremens is a serious and potentially life-threatening form of withdrawal that occurs among those who abuse alcohol, and treatment for this condition is just the first step in the journey toward a sober life. Receiving emergency medical care for delirium tremens stabilizes people who are suffering from the condition, addresses immediate medical needs, and ultimately saves lives. Following this initial treatment, it is essential for patients to engage in addiction treatment services, since medical care alone does not address the underlying psychological issues that led to the development of an alcohol use disorder. Without comprehensive addiction services, patients are at risk of relapsing and finding themselves in another situation where alcohol withdrawal and complications like delirium tremens become a problem.

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1) https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978420/

3) https://onlinelibrary.wiley.com/doi/full/10.1111/acps.13006

4) https://www.the-hospitalist.org/hospitalist/article/123281/dealing-dts

5) https://www.sciencedirect.com/science/article/pii/S0973688318300562

6) https://pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf

7) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659078/

8) https://store.samhsa.gov/sites/default/files/d7/priv/sma10-4554.pdf