When someone is struggling with alcohol use disorder, they 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 serious complications of alcohol withdrawal is a condition known as 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 is a severe, sudden change in the nervous system that can occur after heavy alcohol use is stopped. It 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.
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. When someone suddenly stops consuming alcohol, the brain can become overly excited, which can cause tremors and delirium, which are the hallmark signs of DT.
There are some people with alcohol use disorder who may have increased risk for DT than others. Some risk factors for DT are:
- Chronic alcohol use (especially use for more than ten 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 alcohol detox
- Having a head injury
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 can worsen very quickly after they start.
Common symptoms of DT include:
- Mental function changes
- Irritability and agitation
- Sudden mood changes
- Deep sleep or stupor
- Increased sensitivity to light or sound
How Long Does DT Last?
Delirium tremens can last for 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 six and twelve hours after the last drink. Hallucinations may set in within 12–24 hours after the last drink and can last for two days in some cases. Seizures due to withdrawal may occur within two to three days after the last drink, and delirium tremens occurs within this time frame as well. Most people with DT begin to feel better after about a week.
Delirium tremens is a serious condition and requires medical treatment if it happens. 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 is not able to 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 various 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
Treating DT quickly is crucial since DT can be fatal. The risk of death from DT is approximately 37% if it is not treated appropriately and in a timely manner. Treatment usually involves hospitalization, fluid replacement, anti-seizure medication, sedative medication, antipsychotic medication and pain/fever medication. It is recommended that most people who undergo treatment for DT seek rehab for alcohol use disorder once they have recovered.
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 to not 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 to seek treatment if any 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.
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