This article has been medically reviewed by Dr Robert Lefever, a world-leading addictions specialist.
Delirium tremens or DTs is the most severe complication that comes to the withdrawal of alcohol. When a person with alcohol dependency discontinues drinking suddenly, they can develop delirium tremens.
It is manifested by the abrupt change in the mental state and the hyperactivity of the sympathetic nervous system. It is mainly caused due to the difference in the level of functioning in the nervous system. Moreover, it is associated with confusion, disorientation, irritability, restlessness, hallucinations, mood swings, and tremors.
About 20% of people abuse alcohol during their lifetime, and half of them have the chance of developing withdrawal symptoms upon discontinuing alcohol use. In addition, the chances of developing delirium tremens in such people are approximately 3 to 5%. And the mortality rate for people without treatment of withdrawal symptoms is 15 to 40%.
Delirium tremens is a medical emergency that needed to be treated immediately. If you or any of your loved ones are suffering from this condition, call 0203 955 7700, and help4addiction will be at your service.
WHO ARE AT THE RISK OF DEVELOPING DTs?
This condition is mainly associated with heavy drinkers, and they drink beyond the recommended amount. On withdrawal, DTs can develop due to the altered functioning of the nervous system.
It can also develop in people with
- Head injury
- Any illness along with alcohol abuse
- History of seizures
- Individual History of DTs
- Family history of DTs
It commonly occurs in those individuals having a history of alcohol usage for more than ten years. DTs are common in people who drink for several months more than
- 1 pint of hard alcohol
- 4-5 pints of wine
- 7-8 pints of beer
Delirium tremens simulate the symptoms of the withdrawal of benzodiazepines and correlated drugs. The time in which symptoms of alcohol discontinuation can occur starts as early as two hours. But usually, they appear after six to eight hours. They reach their peak in 48 hours and can continue for five to seven days.
WHAT IS THE PATHOPHYSIOLOGY OF DELIRIUM TREMENS?
Prolonged drinking habits make your brain dependent on alcohol. It is associated with changes in the nervous system. If your brain is used to heavy drinking, then on withdrawal, it becomes difficult for it to perform normally.
You feel a sense of relaxation on drinking because of the inhibitory effects caused by the alcohol on the brain neurotransmitters. It inhibits the excitatory neurotransmitters and enhances the effect of inhibitory neurotransmitters. Or you can say that it interacts with the GABA inhibitory neurotransmitter suppressing the activity of excitatory neurons. It also acts on NMDA receptors as receptor antagonists.
Moreover, alcohol inhibits the function of the excitatory neurotransmitter glutamate at NMDA receptors. So the brain cells are adapted to suppress these inhibitory effects to perform normally. When an individual with heavy drinking habits discontinues using it suddenly, the brain can’t cope with the sudden surge of the neurotransmitters adapted to work in an inhibitory environment created by alcohol. As a result, the individual suffers from alcohol withdrawal in the form of restlessness, agitation, excitement, and delirium.
As the brain was adapted to up-regulation, on the sudden discontinuation, neurotransmitters become excessive in the brain and alter the normal functions of the brain resulting in delirium tremens.
In case anyone is experiencing such a condition, help4addiction is here to help. Call 0203 955 7700 and start consultation to get help as soon as possible.
WHAT ARE THE SYMPTOMS OF DELIRIUM TREMENS?
Most of the symptoms associated with alcohol withdrawal usually start appearing in between 48 to 96 hours. Minor signs of alcohol withdrawal can include fear, nausea, anxiety, or tremors. Significant symptoms of sudden alcohol discontinuation include hallucinations, delirium, hypertension, or seizures. The symptoms can be so severe that if urgent medical treatment is not provided, it can lead to cardiovascular collapse.
The most common symptoms of alcohol withdrawal are as follow:
- Shaking or shivering
- Confused mental state
- Delusions and Hallucinations
- Chest pain
- Tachycardia (increased heart rate)
- Uncontrolled eye and muscle movements
- Mood swings
- Sensitivity towards light, touch, and pain
- Seizures or tremors
Due to hyperactivity of the brain, the individual may often experience the sensation of something running on their body and see and hear things that don’t exist. It is not an easy condition to cope up with until proper medical care is not provided. Moreover, the individual can suffer from seizures which can cause other injuries.
WHAT ARE THE SCREENING TESTS THAT CAN EVALUATE DTs?
If you are suffering from any of the above symptoms, you should contact your general practitioner immediately. Your medical officer will diagnose based on the history and some screening tests.
History of alcohol abuse makes a person more vulnerable to DTs. The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) is a questionnaire that includes ten statements. This questionnaire is used to assess or evaluate the severity of alcohol abuse. If the score is 8 points or low, it correlates to mild withdrawal. If the score is between 9 to 15, then it correlates to moderate withdrawal. And if it is greater than 15, it means the person is suffering severe withdrawal from alcohol abuse. This scoring is usually based on the symptoms of anxiety, irritation, excessive sweating, and other symptoms mentioned above.
Your doctor can also perform the toxicology screen test to evaluate the level of substance abuse or keep track of the level of intoxication by alcohol. Other tests that are performed to screen the intoxication of alcohol in your body are:
- Comprehensive metabolic panel
- Blood phosphate level test: low phosphate level indicates alcohol intoxication.
- Blood magnesium level test: low magnesium level also indicates alcohol abuse.
- Electrocardiogram: abnormal heart functioning can result in arrhythmias that may be due to intoxication of alcohol
- Electroencephalogram: abnormal functioning of the brain can be detected through this test.
WHAT ARE THE COMPLICATIONS ASSOCIATED WITH ALCOHOL ABUSE?
Alcohol abuse not only comes with Delirium tremens, but it can result in other severe complications, which are as follow:
- Liver diseases: Individuals with heavy drinking habits for a more extended period or binge drinking can result in a fatty liver that can progress to cirrhosis. It can complicate the existing symptoms and lead to liver failure.
- Aspirational pneumonitis: Chronic alcohol abuse can increase the vulnerability to respiratory infections, including sepsis and pneumonitis.
- Cardiomyopathy: Excessive alcohol use can result in abnormal functioning that leads to dilation and hypertrophy of the heart.
- Respiratory failure is a severe complication that can result in the progression of respiratory or associated disorders.
- Hypothermia and Hyperthermia
- Neuropathy: Alcohol can result in nerve damage if used excessively and for more extended periods.
- Wernicke-Korsakoff syndrome: It is a brain disorder that can be related to the overconsumption of alcohol.
- Rhabdomyolysis: it is a potentially harmful condition caused by the breakdown of the skeletal muscle fibres. One of the causes of this condition is alcohol abuse.
WHAT ARE THE INTERVENTIONS FOR THE TREATMENT OF DELIRIUM TREMENS?
The medical emergency regarding alcohol withdrawal should be treated according to the symptoms the individual presents.
- Electrolyte imbalance is corrected through the usage of IV fluids
- Use of antipsychotics to prevent delusions and hallucinations
- Sedatives are given to avoid restlessness, irritation, or agitation
- Seizures are controlled with the help of anticonvulsants
- Analgesics and antipyretics are used to treat body pain and fever
The primary purpose of the treatment is to provide stability to the individual to function normally without any complications and comorbidities. Drug regimens that usually treat complications related to symptoms are in use for the patients of alcohol withdrawal. Benzodiazepines, Valium, and Ativan are usually used to treat psychotic abnormalities.
To conduct long term goals for the treatment of Delirium Tremens, the medical specialists follow the following methods:
- Counselling of the patient
- Abstinence of alcohol totally or for a more extended period
- Guidance from the supports groups
It becomes complicated for patients to control urges, especially those who have a lifelong dependency on alcohol. As a result, the individual may relapse again and again. However, support groups help people get out of their addictions to live healthy lives and survive as better individuals.
Behavioural therapies are also used for people with alcohol abuse. It helps the individuals quit alcohol slowly with time to not fall back into their addiction. Also, their brains can get the time to adapt to the new condition of the body.
Even after the treatment, the following symptoms can be seen in the patients with delirium tremens:
- Mood changes
Delirium tremens is potentially a fatal condition if it is not treated at a proper time. Demographically white people are more prone to the symptoms of alcohol abuse. So it should be considered mandatory to use alcohol in the standard provided limit. One must avoid alcohol dependence. But if somebody is suffering from alcohol abuse, they should ask for help. Contact help4addiction at any moment by calling 0203 955 7700. Help4addiction provides all the services for the recovery of the patient.
Frequently Asked Questions
What can you do to treat delirium tremens?
What is the best treatment for delirium tremens?
Is delirium tremens a medical emergency?
One must not waste time in bringing the individual suffering from delirium tremens to the hospital.