Delirium Tremens

What is Delirium Tremens?

Delirium Tremens, known as DTs, is the most severe and dangerous type of withdrawal from alcohol. Only 3-5% of people who experience withdrawal symptoms due to alcohol use disorder experience the DTs, and it usually occurs within the first 48 to 72 hrs after stopping.

However, this statistic only counts those who seek professional help. Likely, many more people experience symptoms but are not treated; if left untreated, the chances of dying of the DTs is 20%.

There is no specific way of measuring or predicting who will experience delirium tremens when they stop drinking. There are several factors involved, but there is no telling if a person will have them or not.

What Causes Delirium Tremens?

Most people are not aware of how alcohol impacts their brain. The effect on our bodies is obvious; we feel more relaxed, have decreased stress and are less coordinated.

This is the impact of central nervous system depression. Alcohol is sedating our CNS, causing these symptoms.

The effect originates in our brains. Our GABA receptors, the part of our brain responsible for feeling calm and happy are tricked by alcohol. Ethanol fools your brain into thinking you are relaxed and happy.

Do this for too long, and your brain will drop its natural level of GABA to compensate. Once this happens, you will grow more and more hyper-stimulated when you are not drinking.

Once this reaches extreme levels, it can disrupt the pathways in your brain, leading to many of the symptoms of DTs.

Another factor in delirium tremens is a deficiency in vitamin B or thiamine. Excessive drinking over a long period depletes this vital nutrient in your system. It can lead to a life-threatening condition called Wernicke’s Encephalopathy.

Risk Factors for DTs

There are several patterns in sufferers of delirium tremens although there is not sure-fire way to know if you will have them or not.

• A history of seizures
• Males experience DT more commonly than females
• Being unmarried & living alone
• Alcohol Use Disorder
• History of detoxification
• Liver, kidney or heart disease
• Over the age of 30

The chances of having delirium tremens are around 4% in people with severe alcohol withdrawal.

Symptoms of Delerium Tremens

Symptoms of alcohol withdrawal have a huge range. Many people may question if they are even having alcohol withdrawal symptoms. The most noticeable at first are shaking and tremors alongside confusion.

Delerium tremens complicate the matter as they often manifest after the initial few days of detoxing from alcohol. 24-78 hours is the most common time when DTs will get worse to the point of being dangerous.

Symptoms include:

• Shaking
• Hallucinations
• Confusion
• Agitation
• Cardiovascular collapse
• Coma
• Death

As with all withdrawal symptoms, delirium tremens can vary in the exact symptoms and how severe they are.

Regardless of how severe the symptoms are, people with delirium tremens need immediate medical help. The chances of dying of DTs is 37% without medical intervention. Even with medical help, around two in a hundred patients will still die of DTs.

Do These Symptoms Mean I Have DTs

If you are withdrawing from alcohol after heavy use, the above symptoms are certainly strong signs of having delirium tremens. It is important that you speak to a doctor to confirm if you are having DTs.

It is possible, however, to have some of the above without it, meaning delirium tremens. Confusion and agitation are quite common in alcohol withdrawal. However, the level you experience with delirium tremens is much more severe than you would commonly expect with alcohol withdrawal.

Tremors and slight shaking are also less severe symptoms in many people withdrawing from alcohol. It is a sign of delirium tremens, but if it is mild and does not get gradually worse, it may not mean you have the DTs.

Delirium Tremens vs. Alcoholic Hallucinosis

Related to the same brain issues as DTs, alcoholic hallucinosis is quite common in people going through alcohol withdrawal.

It is important to know the difference between them and hallucinosis, which, while frightening, is not a significant risk to your life.

AH is usually a result of nutritional deficiencies, particularly vitamin B and thiamine. These can also contribute to DTs making the two conditions related but not identical.

The differences in symptoms are good to know. Alcoholic hallucinosis symptoms may be less severe hallucinations. AH occurs earlier in withdrawal, usually within a day of stopping drinking, whereas DTs appear two to three days after stopping.

DTs usually include tremors and shaking, as well as confusion, which does not usually occur in alcohol hallucinosis. Delirium tremens also gets worse with time and does not happen as suddenly as hallucinosis, which can often appear out of the blue.

Delirium Tremens Treatment

DTs need immediate treatment when you notice any symptoms. You can receive medication for delirium tremens while in a hospital or a private rehab facility.

Treatment improves the chances of surviving delirium tremens from 63% to 98%. A combination of benzodiazepines, Valium, Librium and thiamine are used to regulate the heart rate and reduce tremors and hallucinations.  

Depending on the medication you take, you may need to stay in a detox unit, but in other cases, you can go home if you are stable.

Treatment for delirium tremens is usually reactionary as and when symptoms show. This keeps the level of medication and the length of detox as low as possible.

Having levels of drugs such as benzodiazepines at a minimum is important not only to improve functioning but also to prevent secondary addictions. Many of the medications used to treat delirium tremens are themselves addictive.

People with a history of seizures, either from alcohol detox or other medical conditions, will need to be hospitalised or stay in a dedicated rehab unit.

Intensive Care for Delerium Tremens

In some cases, DTs are too severe for normal sedative treatments to work. If this happens, a hospital will provide barbiturates alongside benzodiazepines.

These medications require hospitalisation and may mean intensive care due to the effect they can have on a patient’s breathing.

Risks of Delaying Treatment for DTs

People with delirium tremens very commonly deteriorate with time. The rate of mortality for those who get treatment ranges from 2% to 15% with the length of time you wait for medical or rehab help.

The likelihood of having DTs and progressive symptoms also increases with the amount of time you wait.

Rehab and Delirium Tremens

You can consult your doctor about delirium tremens, and if they are severe enough, you may be hospitalised or given a prescription to help.

You also have the option of staying in a residential rehab centre. Most have a dedicated detox unit with doctors who can prescribe and supervise your stay.

Using your medical history and personal preferences as a guide, the rehab team will develop a treatment plan for you.