What is Delirium Tremens?
Delirium tremens (DTs) is a serious and potentially life-threatening condition that can occur with chronic alcohol abuse. When alcohol use suddenly stops after a period of excessive use, it can cause withdrawal from alcohol to begin, and in severe cases DTs.1
According to research, three to five percent of those who stop using alcohol will experience severe withdrawal with DTs. Without proper treatment, 37% of people will die following this condition.1
Understanding Delirium Tremens
Withdrawal Seizures First
To understand DTs, it is crucial to know the difference between this condition and alcohol withdrawal seizures. Doctors report that seizures from alcohol withdrawal typically begin 12 to 48 hours after a person last consumes alcohol. But they can take place as soon as two hours after the last alcoholic drink.2
Seizures from alcohol withdrawal are most common among those between the ages of 30 and 50, and they occur with chronic alcohol abuse. Seizures themselves do not represent DTs, but when people do not receive proper medical treatment of the seizures, they can progress to delirium tremens in 30% of people.2
How are DTS Different Than Withdrawal Seizures?
Delirium tremens is a separate condition from alcohol withdrawal seizures. It involves the following symptoms:2
- Hallucinations
- Mental Confusion
- Elevated Heart Rate and Blood Pressure
- Agitation
- Increased Body Temperature
- Sweating
How Much Do You Have to Drink to Get Delirium Tremens?
Delirium tremens occurs with chronic and excessive alcohol abuse. According to research, people are more likely to experience DTs if they have an alcohol content (BAC) of .20 or above upon admission to the hospital for treatment.3 To reach a BAC of .20, a 150-pound person would have to consume about ten alcoholic beverages in four hours, which most people would agree is rather excessive.4
How Long Does Delirium Tremens Last?
DTs is a risk factor associated with excessive alcohol consumption, and unfortunately, it does not go away quickly on its own. According to experts, delirium tremens begins as early as two days after one with chronic alcohol abuse stops drinking, and it can last for up to five days.
What is the First Sign of Delirium Tremens?
While not all cases of alcohol withdrawal lead to delirium tremens, research shows that over half experience some withdrawal symptoms after stopping or reducing chronic alcohol consumption.1 Initial withdrawal symptoms in minor cases include anxiety, upset stomach, sleep problems, headaches, and heart palpitations.1
In more severe cases of withdrawal, initial symptoms can progress to visual hallucinations and then seizures, so both hallucinations and seizures may be the first sign of DTs.1 Since untreated seizures can lead to delirium tremens, it is vital to seek treatment once seizures occur, as this may be a sign that delirium tremens is on the horizon.
What About the Shakes?
Tremors, often called “the shakes,” are also a common withdrawal symptom seen among those who suddenly stop drinking after chronic alcohol abuse, and they can occur with DTs as well. According to medical experts, tremors occur because of nervous system disruptions when one stops drinking. They typically reach their peak severity between ten to thirty hours after a person takes his or her last drink, and they slowly fade away about two days after the last alcohol consumption.5
Stopping the Shakes
Typically, tremors, or “the shakes” will fade away with time. Magnesium may also be beneficial for alleviating general alcohol withdrawal symptoms and can be useful for helping the shakes to stop. Aside from magnesium, it is helpful to stay in a quiet environment with low lighting and drink plenty of fluids to more comfortably overcome alcohol withdrawal symptoms like tremors.6
Delirium Tremens Treatment
As discussed, a significant portion (37%) of untreated cases of DTs will be fatal, so once alcohol withdrawal progresses to this level, more than fluids and a peaceful environment is needed. Formal treatment is necessary to ensure the safety of patients who suffer from DTs during alcohol withdrawal. Typically, treatment will need to occur in a hospital setting, where the goal is to prevent complications, reduce agitation, ward off seizures, and keep the patient alive.1
Most often, benzodiazepines are given via an IV to treat delirium tremens. The dose and specific type of benzodiazepine can differ based upon a patient’s unique needs.
In more severe cases of DTs, patients are also treated with barbiturate medications along with a benzodiazepine drug. Some patients may also take clonidine and dexmedetomidine along with a benzodiazepine.
Drugs Used to Treat DTS
The following benzodiazepine drugs may be used to treat delirium tremens:1
Nutritional Treatments
Beyond using medications to treat delirium tremens, some nutritional interventions may be necessary. For example, dehydration is a complication of alcohol withdrawal, so IV fluids may be necessary to restore health to some patients with delirium tremens. Those who chronically abuse alcohol may also be deficient in key minerals, such as magnesium, phosphate, and sodium, so supplementation may be required. Thiamine and folic acid supplementation are also beneficial for recovery from severe alcohol withdrawal.6
DTS Can be Deadly, Get Help at the First Signs
Delirium tremens is a severe, potentially life-threatening form of alcohol withdrawal, but it can be treated. If you or someone you love are experiencing alcohol withdrawal, and are suffering from severe symptoms, like seizures or confusion, seek treatment in an emergency room to stabilize the condition and prevent serious complications. After completing this initial phase of treatment, it is crucial to complete ongoing behavioral therapy, whether on an inpatient or outpatient basis, to help continue to live a life free from alcohol.
Resources
- https://www.ncbi.nlm.nih.gov/books/NBK482134/
- https://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes
- https://www.ncbi.nlm.nih.gov/books/NBK65581/
- https://www.utc.edu/center-student-wellbeing/alcohol-drug-education/bloodalcoholcontent.php
- https://www.news-medical.net/health/Tremors-Following-Alcohol-Dependency.aspx
- https://pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf
