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Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or neurological changes.

DT's; Alcohol withdrawal - delirium tremens

Delirium tremens can occur after a period of heavy alcohol drinking, especially when the person does not eat enough food.

It may also be triggered by head injury, infection, or illness in people with a history of heavy alcohol use.

It is most common in people who have a history of alcohol withdrawal. It is especially common in those who drink the equivalent of 4 - 5 pints of wine or 7 - 8 pints of beer (or 1 pint of "hard" alcohol) every day for several months. Delirium tremens also commonly affects those who have had a history of habitual alcohol use or alcoholism for more than 10 years.

Symptoms most commonly occur within 72 hours after the last drink, but may occur up to 7 - 10 days after the last drink. Symptoms may get worse rapidly, and can include:

• Body tremors
• Mental status changes
  • Agitation, irritability
  • Confusion, disorientation
  • Decreased attention span
  • Decreased mental status
    • Deep sleep that persists for a day or longer
    • Stupor, sleepiness, lethargy
    • Usually occurs after acute symptoms
  • Delirium (severe, acute loss of mental functions)
  • Excitement
  • Fear
  • Hallucinations (such as seeing or feeling things that are not present are most common)
  • Highly sensitive to light, sound, touch
  • Increased activity
  • Mood changes rapidly
  • Restlessness, excitement
• Seizures
  • Most common in first 24 - 48 hours after last drink
  • Most common in people with previous complications from alcohol withdrawal
  • Usually generalized tonic-clonic seizures
• Symptoms of alcohol withdrawal
  • Anxiety
  • Depression
  • Difficulty thinking clearly
  • Fatigue
  • Feeling jumpy or nervous
  • Feeling shaky
  • Headache, general, pulsating
  • Insomnia (difficulty falling and staying asleep)
  • Irritability or easily excited
  • Loss of appetite
  • Nausea
  • Pale skin
  • Palpitations (sensation of feeling the heart beat)
  • Rapid emotional changes
  • Sweating, especially the palms of the hands or the face
  • Vomiting

Additional symptoms that may occur:

• Chest pain
• Fever
• Stomach pain

Delirium tremens is a medical emergency.

The health care provider will perform a physical exam. Signs may include:

• Heavy sweating
• Increased startle reflex
• Irregular heartbeat
• Problems with eye muscle movement
• Rapid heart rate
• Rapid muscle tremors

The following tests may be done:

• Chem-20
• Electrocardiogram (ECG)
• Electroencephalogram (EEG)
• Toxicology screen

For additional resources, see alcoholism support group.

Delirium tremens is serious and may be life threatening. Symptoms such as sleeplessness, feeling tired, and emotional instability may persist for a year or more.

• Heart arrhythmias, may be life threatening
• Injury from falls during seizures
• Injury to self or others caused by mental state (confusion/delirium)
• Seizures

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms. Delirium tremens is an emergency condition.

Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.

For more information, see: Alcoholism

O’Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.