Delirium tremens

Definition

Delirium tremens is a severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.

Alternative Names

Alcohol abuse - delirium tremens; DTs; Alcohol withdrawal - delirium tremens; Alcohol withdrawal delirium

Causes

Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food.

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

It occurs most often in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints (1.8 to 2.4 liters) of wine, 7 to 8 pints (3.3 to 3.8 liters) of beer, or 1 pint (1/2 liter) of "hard" alcohol every day for several months. Delirium tremens also commonly affects people who have used alcohol for more than 10 years.

Symptoms

Symptoms most often occur within 48 to 96 hours after the last drink. But, they may occur 7 to 10 days after the last drink.

Symptoms may get worse quickly and can include:

Seizures (may occur without other symptoms of DTs):

Symptoms of alcohol withdrawal, including:

Other symptoms that may occur:

Exams and Tests

Delirium tremens is a medical emergency.

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

The following tests may be done:

Treatment

The goals of treatment are to:

A hospital stay is needed. The health care team will regularly check:

While in the hospital, the person will receive medicines to:

Long-term preventive treatment should begin after the person recovers from DT symptoms. This may involve:

Treatment may be needed for other medical problems that can occur with alcohol use, including:

Support Groups

Attending a support group regularly is a key to recovering from alcohol use. More information and support for people with alcohol use disorder and their families can be found at:

Outlook (Prognosis)

Delirium tremens is serious and may be life-threatening. Some symptoms related to alcohol withdrawal may last for a year or more, including:

Possible Complications

Complications can include:

When to Contact a Medical Professional

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

If you go to the hospital for another reason, tell the providers if you've been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.

Prevention

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

If you have a drinking problem, it is best to stop drinking alcohol completely. Total and lifelong avoidance of alcohol (abstinence) is the safest approach.

References

Kelly JF, Renner JA. Alcohol-related disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 26.

O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 30.



Review Date: 2/28/2023
Reviewed By: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
© 1997- adam.comAll rights reserved.
A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.