Delirium Tremens - Causes, Symptoms, Diagnosis and Treatment

What Is Delirium Tremens?

Delirium tremens (DT), also called alcohol withdrawal delirium (AWD), is a sudden and severe form of confusion that occurs due to alcohol withdrawal. The symptoms of delirium tremens start about two to three days after stopping the alcohol intake in people who have been drinking alcohol for a long period of time.

The experience of delirium tremens varies from person to person. It depends on the frequency and duration of their previous alcohol consumption. It is said that about five percent of people who undergo alcohol withdrawal get delirium tremens. When it is left untreated, it may lead to stroke, heart attack, and death.

What Are the Causes of Delirium Tremens?

Delirium tremens occur in people who consume alcohol heavily, meaning drinking eight or more drinks in a week in women and 15 or more in men, and quickly reduce their alcohol intake or suddenly stop it altogether. A drink includes 340 grams of beer, 198 grams of malt liquor, 141 grams of wine, and 42 grams of distilled spirits such as rum, whiskey, or vodka. On stopping the alcohol suddenly after drinking for a long period, the brain continues to work in the state that it was working so far, resulting in alcohol withdrawal symptoms. When we suddenly stop alcohol usage, the brain and the nervous system will not be able to adjust quickly, and it becomes overstimulated.

In addition, people have an increased risk of developing delirium tremens when they:

1. Already had delirium tremens in the past.

2. Experienced alcohol withdrawal in the past.

3. Have a history of seizure disorder.

4. Adult men who are unmarried, white, and younger.

5. An alcohol use disorder or heavy and long-term drinkers.

All these result in some of the symptoms of delirium tremens, such as:

1. Extreme high blood pressure.

2. Tremors.

3. Severe excitability.

4. Seizures.

Thus, delirium tremens is severe and potentially fatal.

What Are the Symptoms of Delirium Tremens?

The symptoms of delirium do not show up right away; also, it develops after two days to four days of the last drink. In some cases, symptoms do not occur even up to ten days after quitting alcohol. It is normal for every person who stops drinking for a couple of days due to certain occasions to experience milder alcohol withdrawal symptoms, and this becomes increasingly severe after 48 hours to 96 hours.

Physical Symptoms:

The following are the physical symptoms of delirium tremens.

1. Fever.

2. Chest pain.

3. Fatigue.

4. Nausea or vomiting.

5. Stomach pain.

6. Sensitivity to light and sound.

7. Dehydration.

8. Deep sleep lasts for a day or longer.

9. Pale skin.

10. Heavy sweating.

11. Increased heart rate.

12. Shaking of hands and feet or tremors.

13. Other tremors such as muscle tremors.

14. Involuntary muscle contractions or movements.

15. Seizures.

16. Rapid heartbeat.

17. Breathing difficulties.

18. High blood pressure.

19. Problems with eye muscle and its movement.

Psychological Symptoms:

Psychological symptoms are also common; they are:

1. Anger or anxiety.

2. Confusion.

3. Nightmares.

4. Delirium.

5. Severe hyperactivity.

6. Delusions.

7. Getting startled more easily.

8. Disorientation.

9. Excitement.

10. Fear.

11. Hallucinations.

12. Irritability.

13. Rapid mood changes.

14. Sleepiness or stupor.

Delirium tremens make our body temperature, the way of breathing, or blood circulation change quickly. This leads to life-threatening complications such as:

1. Sepsis.

2. Irregular heartbeat.

3. Trouble breathing.

4. Seizures.

5. Electrolyte imbalance (minerals in the body are unable to control the body’s functions).

Symptoms of delirium tremens usually resolve within a few days; however, they are serious and need medical attention. So, people who have the signs of delirium tremens should get immediate treatment in the hospital.

How Is Delirium Tremens Diagnosed?

The doctor will do a physical examination, ask about the present and previous medical history, and will discuss the symptoms he or she is undergoing. Some of the symptoms that they particularly look at are dehydration and fever. The doctor will listen to the heart sounds to know if there are any signs of a rapid or irregular heartbeat.

In addition, the doctor may ask the loved ones who are with the patient or the caregiver a certain set of questions from a questionnaire called a Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar). This assessment helps the doctor to determine and measure the nature and severity of the symptoms. When the score is 15 or higher, it indicates that the person is at high risk for delirium tremens.

The doctors will conduct a variety of laboratory tests; they are:

1. Blood Tests - Blood magnesium levels and blood potassium levels are checked. When the magnesium and potassium serum levels in the blood are very low, then the heart will not have the ability to function normally. This is a sign of severe withdrawal or severe alcoholism.

2. Electrocardiogram (ECG) - It helps to detect the heart's electrical activity to evaluate the functioning of the heart.

3. MRI (Magnetic Resonance Imaging) - It helps to look for the symptoms of seizures or head injury.

4. Electroencephalogram (EEG) - This test affects the brain's electrical activity. Severe alcohol withdrawal results in changes in the brain, leading to seizures.

5. Lumbar puncture test to examine spinal cord fluid.

6. Metabolic panel.

7. Toxicology Screen - It measures the alcohol present in the body, which is identified with the blood or urine sample.

In addition, the doctor also checks the heart, the nerves in the feet, liver, and the digestive tract to know how much the alcohol has damaged the body.

How Is Delirium Tremens Treated?

Delirium tremens is treated at the hospital. The most commonly used medication for delirium tremens and alcohol withdrawal is benzodiazepines which help to calm the elevated nervous system. The other medications that are used to treat acute delirium tremens include:

1. Pain medication.

2. Blood pressure medications.

3. Anticonvulsant medications to stop seizures.

4. Antipsychotic drugs to prevent hallucinations.

5. Medicines to regulate heartbeat.

Intravenous fluids of vitamins and minerals are needed to treat dehydration or to help bring back the electrolytes in balance.

Conclusion:

When there are any abnormal symptoms after alcohol withdrawal, get medical help immediately. The patient might be asked to stay in the hospital for a week to stabilize his or her health and to get treated for alcohol dependence. SAMSHA is the Government’s Substance Abuse and Mental Health Services Administration which is an online treatment facility locator. It helps to improve the health conditions of people with alcohol withdrawal and delirium tremens. For a healthy mind, get treatment at the earliest as prolonged delirium tremens can lead to diagnostic dilemmas.