Delirium Tremens: Symptoms, Causes, Treatment and Prevention

Someone struggling with alcohol use disorder might be concerned about alcohol withdrawal. Withdrawal from alcohol is a very uncomfortable process that can be dangerous and even deadly. One of the more severe complications of alcohol withdrawal is delirium tremens (DT). Delirium tremens is a serious condition that can be deadly if not treated appropriately. DT may also be referred to as alcohol withdrawal delirium.

What Is Delirium Tremens (DT)?

Delirium tremens (DT) is a severe form of alcohol withdrawal that can cause rapid onset of confusion, shaking, shivering, irregular heart rate, sweating and hallucinations. It typically occurs three days into alcohol withdrawal and lasts two to three days. If you or someone you know is experiencing DTs, it is important to seek medical attention immediately.

Delirium tremens usually happens in people who have used alcohol for long periods and can be worsened if the person has not eaten any food in a while. DT is characterized by tremors, delirium (a sudden episode of confusion), agitation and mental function changes.

Delirium Tremens Causes and Risk Factors

Drinking large amounts of alcohol for long periods can harm the brain. An example of this kind of heavy alcohol use is consuming four to five pints of wine, seven to eight pints of beer or one pint of hard liquor daily for multiple months. Alcohol interferes with your body’s ability to regulate certain brain chemicals. 

Alcohol Withdrawal 

Alcohol suppresses brain activity. When someone suddenly stops consuming alcohol, the brain can become overly excited. While this may only cause the normal symptoms of alcohol withdrawal, severe effects can cause tremors and delirium, which are the hallmark signs of DT.

Some people with alcohol use disorder may have an increased risk for DT than others. Some risk factors for DT are:

• Chronic alcohol use (especially use for more than 10 years)
• History of DT in the past
• History of seizures
• Being ill or having chronic health problems like heart or liver disease
• Previous unsuccessful attempts at an alcohol detox
• Having a head injury

Benzodiazepine Withdrawal

When someone who heavily uses alcohol withdraws from benzodiazepine at the same time they are withdrawing from alcohol, it can have a greater effect on the receptors in the brain and increase the risk of delirium tremens. Benzodiazepines are used to treat delirium tremens, and suddenly stopping them could theoretically even trigger delirium tremens in a heavy drinker who is still using alcohol. 

Metabolic Factors

Someone’s risk of developing delirium tremens during alcohol withdrawal is higher if they have certain metabolic factors. A deficiency of thiamine (vitamin B1) can increase the risk of DTs. Electrolyte imbalances or dehydration could also lead to an increased risk of DTs during withdrawal.

Infections, Trauma and Other Causes

Someone withdrawing from alcohol may be more likely to experience DTs if another stress affects the body during withdrawal. This includes trauma, infection or even stress caused by an illness. Many times this risk factor is relevant when someone who drinks heavily is hospitalized for another cause, like a serious car accident, for example, and ends up not having access to alcohol while they are hospitalized.

Symptoms of Delirium Tremens

Symptoms of DT start after some time has passed since a person’s last drink of alcohol. Usually, if it happens, it occurs within two to four days of the last drink, but it can occur up to 10 days after the last drink. Symptoms can appear suddenly and worsen very quickly after they start.

Common symptoms of DT include:

• Delirium
• Tremors
• Mental function changes
• Irritability and agitation
• Hallucinations
• Sudden mood changes
• Restlessness
• Deep sleep or stupor
• Increased sensitivity to light or sound
• Fever
• Seizures
• Anxiety

How Long Does Delirium Tremens Last?

Delirium tremens can last up to five days and will begin to subside after reaching a peak. The first stage of alcohol withdrawal, usually with mild symptoms, occurs between 6–12 hours after the last drink. Hallucinations may occur 12–24 hours after the last drink and sometimes last for two days. Seizures from withdrawal may occur within two to three days after the last drink, and delirium tremens also occurs within this time. Most people with DT begin to feel better after about a week.

Long-Term Effects of Delirium Tremens

Delirium tremens is an acute condition and does not typically have long-term effects. The only major long-term effect that could be considered is death. Delirium tremens is fatal in 37% of people if it is untreated. If treated correctly, the odds of dying are much lower, although not insignificantly. The trauma of the experience could be a long-term effect, but other long-term effects are not likely.

Delirium Tremens and Co-occurring Conditions

Delirium tremens is a serious condition and requires medical treatment. As DT is associated with heavy alcohol use over long periods, there are often complications that co-occur with DT. Serious complications associated with heavy alcohol use can increase the chances of death due to alcohol withdrawal since they indicate years of bodily damage due to alcohol and may be very difficult to treat.

Some of these possible complications include:

• Alcoholic liver disease: Damage to the liver due to alcohol use may occur, which decreases the ability of the liver to function properly.
• Heart failure: Long-term use of alcohol can be associated with alcoholic cardiomyopathy, a type of heart failure where the heart cannot pump blood normally and must work very hard to send oxygen around the body.
• Nerve damage: Permanent damage to the nervous system may occur with heavy drinking, which can cause tingling, numbness, muscle disorders and pain.
• Wernicke-Korsakoff Syndrome: This is a disorder of the brain related to long-term alcohol use disorder that is usually associated with permanent brain damage. This syndrome has symptoms such as memory loss and muscular disorders.

Diagnosing Delirium Tremens

It is important to seek treatment right away if you or someone you know seems to be withdrawing from alcohol and has concerning symptoms. A medical professional can diagnose DT and will perform a physical exam along with different medical testing.

Some assessments that might be performed to diagnose DT are:

• Checking for tremors, heart rate irregularities, dehydration and fever
• Toxicology blood testing to determine how much alcohol is in the system
• Checking magnesium and phosphate levels in the blood
• Brain and heart scans
• A questionnaire called the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar), which is a series of questions to help determine whether someone is in alcohol withdrawal

Delirium Tremens Treatment

Quickly treating DT is crucial since DT can be fatal. The risk of death from DT is approximately 37% if it is not treated appropriately and promptly. It is recommended that most people who undergo treatment for DT seek rehab for alcohol use disorder once they have recovered. Treatment usually involves: 

• Hospitalization
• Fluid replacement
• Anti-seizure medication
• Sedative medication
• Antipsychotic medication
• Pain/fever medication

Preventing Delirium Tremens

Delirium tremens is caused by long-term heavy alcohol use. A good way to prevent DT or reduce the risk of DT is not to drink at all or to only drink in moderation. It is important to pay attention to any concerning symptoms that might indicate alcohol withdrawal and seek treatment if symptoms are worrisome, such as severe confusion and tremors. The only way to completely prevent DT is to avoid alcohol use. Seeking out treatment for alcohol use disorder can be beneficial in helping a person avoid future alcohol use and to live a healthy, sober life without alcohol.

The Recovery Village Ridgefield can help you or a loved one recover from alcohol use disorder. Contact us today and speak with a Recovery Advocate who can assist you on your recovery journey.