Delirium tremens

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 29, 2016
StartDiseasesDelirium tremens

Because withdrawal from alcohol is more dangerous than withdrawal from most other drugs, delirium tremens (DTs) is a life-threatening medical emergency. This severe complication of alcohol withdrawal can result in serious consequences including death.

Contents

Definition & Facts

Delirium tremens is a condition associated with alcohol withdrawal that is severe in nature, and is characterized by sudden and often severe changes, such as confusion and hyperactivity in the central nervous system.

Its name is derived from the Latin words meaning 'trembling delirium', and it describes a group of symptoms including anxiety, severe tremors, and delirium. Delirium refers to disorientation and confusion in the mind characterized by hallucinations.

Commonly known as DTs or “the shakes,” delirium tremens typically attacks heavy alcohol drinkers who withdraw from alcohol abruptly. To be more specific, those who consume approximately 5, 8 or 1 pint of wine, beer, or “hard" alcohol respectively daily for a long period of time, which may run up to years, are at a high risk of developing delirium tremens if they quit abruptly.

Symptoms & Complaints

The symptoms of delirium tremens may vary from one person to another. The variation is due to how different people may have different physiological makeup. The time duration an individual has taken the alcohol and severity of the alcoholism are other factors that may bring about the differences.

Although some people may experience abrupt occurrence of the symptoms following withdrawal from alcohol, most individuals with delirium tremens begin experiencing the symptoms two to three days following alcohol withdrawal. In most cases, the symptoms are at their worst on the fourth or fifth day. Additionally, the symptoms worsen at night.

Common symptoms of delirium tremens include delirium, extreme shakiness, difficulty concentrating, excitement, restlessness, extreme anxiety, prolonged sleeps usually lasting for a whole day or longer, and profuse sweating on the hands and face.

People suffering from this condition may also experience hallucinations, which is a condition in which an individual sees things that do not actually exist; sensitivity to light, sound and touch; high body temperature; skin paleness; thoracic pain; irregular heartbeat; and rapid emotional changes.

Delirium tremens may also result in seizures. Because the condition may cause death, it is advisable to seek immediate medical care when the symptoms appear. This ensures early diagnosis and treatment, which help to prevent possible complications associated with the condition. The complications include injuries from seizure-related falls; arrhythmia due to irregular heartbeat; and frequent and often life-threatening seizures.

Causes

The main cause of delirium tremens is abrupt withdrawal from alcohol after a long period of alcoholism. When an individual abuses alcohol for a long period of time, his or her body becomes accustomed to alcoholism, a condition known as alcohol tolerance. This condition is characterized by certain changes in various body parts such as the liver and the central nervous system. The changes are necessary because they ensure that such body parts adjust accordingly to alcoholism so that they continue functioning normally.

For instance, heavy and prolonged alcohol intake causes an increase in the production of brain neurotransmitters by the body as a way of compensating for the depressant effect of alcohol on the brain. When an alcohol addict quits taking alcohol all of a sudden, the body’s alcohol level drops abruptly. At this point, the body is not able to respond quickly to the low alcohol level by lowering the level of the brain neurotransmitters. This causes delirium tremens.

Other causes of delirium tremens besides abrupt alcohol withdrawal include infection, injury and illness. An individual who uses tranquilizer medications such as barbiturates addictively for a long period of time may also suffer from delirium tremens if he or she stops taking the drugs abruptly. This is because these drugs affect the brain neurotransmitters the same way alcohol does.

Diagnosis & Tests

The diagnosis of delirium tremens involves both a physical examination and tests. Prior to the appointment with a doctor, it is crucial for the affected person to do some preparation. To prepare, the patient may need to record down all the symptoms he experiences, the drugs he takes and all the questions he intends to ask the physician. Prior to the physical examination, the doctor may seek to know, among other things, how long the patient has been taking alcohol, the quantity of alcohol the patient takes per day and when the patient last took alcohol.

During the physical examination, the doctor examines the patient to determine if the patient has the symptoms of delirium tremens. He may check the patient for heavy sweating, irregular heartbeat, rapid muscle tremors and eye muscle movement problem. After the examination, the doctor may perform blood tests to determine the level of nutrients such as magnesium and phosphate in the body. Other relevant tests the doctor may perform during the diagnosis of delirium tremens include toxicology screening, electrocardiograms, and a comprehensive metabolic panel.

Treatment & Therapy

The treatment of delirium tremens focuses on saving the patient’s life, relieving the symptoms of the condition and preventing the related complications. Typically, the patients of this condition need to stay in the hospital during treatment. During the hospital stay, the doctor will administer sedatives to the patient.

Benzodiazepines is one group of sedatives that the doctor can administer in treating delirium tremens. Examples of benzodiazepines include diazepam, oxazepam and lorazepam. Other medications the doctor may administer include anti-seizure drugs, and drugs for anxiety and tremors.

Depending on the patient’s health condition, he or she may have to undergo treatments for other conditions related to alcoholism. Such conditions may include alcoholic liver disease, alcoholic neuropathy and alcoholic cardiomyopathy.

Prevention & Prophylaxis

Preventing delirium tremens involves putting into practice measures that allow for the safe detoxification of alcohol. This can include tapering off of alcohol rather than quitting cold turkey as well as detoxing with the use of drugs such as chlordiazepoxide and withdrawing under the supervision of medical personnel or loved ones.

Additionally, preventive measures against DT's include methods to stop or prevent the abuse of alcohol - both before a person suffers from the condition or after the person has recovered from the condition in order to avoid its recurrence. Such measures include abstinence, which involves quitting alcohol intake for good, and counseling which could involve individual psychotherapy as well as group therapy.