Up to 5% of people going through alcohol withdrawal experience delirium tremens, a potentially life-threatening emergency that has a substantial impact on individuals and their families.
Alcohol withdrawal happens to heavy drinkers who suddenly cut back on drinking. Withdrawal symptoms range from mild to severe, with delirium tremens being the most severe form.
Delirium tremens is characterized by confusion, slowed brain function, agitation, trembling, seizures, tremors, hallucinations, and impaired consciousness that can become fatal when left untreated.
This article comprehensively explores delirium tremens, including its causes, symptoms, global perspectives, and integrative treatment approaches.
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Understanding Delirium Tremens
Learning more about delirium tremens can help you recognize this severe form of alcohol withdrawal and the importance of seeking immediate medical assistance.
Definition and Overview
Delirium tremens is a life-threatening form of alcohol withdrawal requiring medical attention. It's the most severe form of alcohol withdrawal and is considered a medical emergency.
Delirium tremens sometimes develops when an individual with alcohol use disorder suddenly stops drinking alcohol.
Causes of Delirium Tremens
Delirium tremens is caused by changes in alcohol consumption affecting the central nervous system, which controls the body's heart rate, breathing, and other automatic processes.
Because alcohol depresses nervous system activity, the central nervous system can become overactive when you stop drinking suddenly after a history of heavy drinking.
Abruptly stopping alcohol consumption can cause the brain to produce excitatory signals, creating a hyper-arousal state.
Because alcohol use disorder affects nearly 30% of American adults in their lifetime, delirium tremens and its symptoms are concerns to be aware of.
Risk Factors
While alcohol withdrawal is the cause of delirium tremens, not everyone experiences this more severe form. Examples of delirium tremens risk factors include:
- History of heavy drinking, detoxification, or delirium tremens
- History of seizures
- Previous alcohol withdrawal symptoms
- Consuming large amounts of alcohol before withdrawal
- History of severe alcohol withdrawal symptoms
- Older age
- Certain medications and potential interactions with dietary supplements
- Liver disease, heart disease, infections, illnesses, traumatic brain injury (TBI), or other comorbidities
- Psychiatric disorders
- Inadequate nutrition or eating too few calories
- Poor general health
- Low potassium
- History of misusing sedatives or sleep-inducing medicines
Delirium tremens is common among individuals who have used alcohol for more than 10 years. Your risk also increases if you're used to drinking heavily every day for at least several months. However, delirium tremens is rare in individuals under age 30.
Symptoms and Diagnosis
Recognizing delirium tremens symptoms is vital to getting the treatment needed to avoid life-threatening complications.
Common Symptoms
Common delirium tremens symptoms include:
- Confusion
- Disorientation
- Trembling
- Heavy sweating
- Fast heartbeat
- Agitation, irritability, fear, excitement, anxiety, or aggression
- Nausea or vomiting
- Impaired consciousness
- Tremors (shaking)
- Seizures
- Hallucinations
- Paranoia
- Sensory disruptions
- Headaches
- High body temperature or fever
- Deep sleep
- Energy bursts
- Mood changes
- Restlessness
- Fatigue
Seizures are most common within 12-48 hours after your last drink and more likely if you've had previous complications linked to alcohol withdrawal.
Delirium tremens symptoms often appear within 2-4 days after your last drink but might occur 7-10 days after your last alcoholic beverage. They may worsen quickly and be most intense 4-5 days after the last drink.
Delirium tremens often lasts up to 5 days. Studies suggest it has persisted for up to 35 days in rare cases.
Rare Symptoms and Complications
Death is a complication of delirium tremens, mainly when the condition is left untreated. That's why it's vital to consider delirium tremens symptoms a medical emergency and seek help right away.
Complications linked to untreated delirium tremens include:
- Prolonged seizures
- High blood pressure
- Altered mental status
- Global confusion
- Hyperthermia
- Arrhythmias
- Sepsis
- Severe electrolyte imbalances
- Respiratory failure
- Heart problems
- Nutrient deficiencies
- Sleep disturbances
- Aspiration pneumonia
- Depression or anxiety
- Death
Without treatment, delirium tremens has a mortality rate of up to 37%. Seeking treatment early, however, reduces this mortality rate to less than 5%.
Diagnostic Criteria
Guidelines for diagnosing delirium tremens include a medical history review, physical and neurological exams, and the Clinical Institute Withdrawal Assessment for Alcohol Revised Scale (CIWA-Ar), a 10-item questionnaire used to evaluate, monitor, and treat alcohol withdrawal.
CIWA-Ar scores of 8 or lower are classified as mild withdrawal, scores of 9-15 are moderate withdrawal, and CIWA-Ar scores of 15 or greater are severe withdrawal symptoms with a greater risk of seizures and delirium tremens.
Individuals with suspected delirium tremens need to undergo screening for nutrition, electrolyte, and fluid abnormalities, such as dehydration, hypoglycemia, hypophosphatemia, hypomagnesemia, or other electrolyte imbalances.
Providers may order the following diagnostic tests:
- Blood magnesium tests
- Blood phosphate tests
- Blood alcohol level testing
- Comprehensive metabolic panel (CMP)
- Electrocardiogram (ECG)
- Toxicology screening
- Urine testing
- Electroencephalogram (EEG)
Liver, kidney, and heart function tests, as well as CT scans or MRIs of the brain, are also appropriate.
Differential diagnosis is vital to detect other potential medical concerns.
Global Perspectives on Delirium Tremens
Delirium tremens affects individuals worldwide, and perspectives and treatments vary by region.
Prevalence Around the World
About 14% of people worldwide have alcohol use disorder, while over 38% of people in the world drink alcohol. Alcohol is responsible for 3.3 million deaths each year globally.
Studies show that delirium tremens prevalence is less than 1% in the general population and about 2% in people with alcohol dependence.
According to the World Health Organization (WHO), the highest rates of alcohol dependence globally include Belarus (highest prevalence), Latvia, Hungary, the Russian Federation, and the United States.
High alcohol consumption also occurs in Peru, Slovenia, Slovakia, Sweden, Lithuania, Finland, Estonia, Canada, Belgium, Austria, the Republic of Korea, and Switzerland.
Regional Treatment Practices
Conventional medical treatments and adjunctive supportive therapies for delirium tremens vary across cultures.
For example, researchers found that while benzodiazepines are often the medications of choice, some countries (such as Germany and the Czech Republic) also frequently use clomethiazole.
Some cultures lean more heavily on nutritional care and supportive therapy, which are highly beneficial treatments.
Challenges in Global Management
Challenges in the global management of delirium tremens include access to quality medical care, the stigma of receiving treatment for alcoholism, recognizing delirium tremens symptoms as life-threatening, and other societal barriers — such as taking time off from work to recover.
Medical Treatments and Integrative Approaches
While there's no cure for delirium tremens, the following treatments help manage symptoms and avoid serious complications.
Conventional Medical Treatments
Conventional medical treatments include medications that reduce the activity of the central nervous system. Examples include sedatives, particularly benzodiazepines (lorazepam, diazepam, oxazepam, chlordiazepoxide, etc.), or general anesthesia for full sedation.
Barbiturates, propofol, dexmedetomidine, phenobarbital, carbamazepine, and antipsychotics are also sometimes used.
Hospitalization and supportive care are essential to treat dehydration, mineral and vitamin deficiencies, and electrolyte imbalances via intravenous (IV) therapy.
Confusion is a frequent symptom of delirium tremens, so family members of someone struggling with this condition must help make informed decisions about their care.
The main symptoms of delirium tremens often last 3-7 days, but some symptoms can persist for weeks or even months.
Alcohol use disorder treatment may resume after recovering from delirium tremens.
Integrative and Alternative Therapies
In addition to IV nutritional support, patients can be advised to adopt healthy eating patterns and take nutritional supplements as needed.
Mind-body practices, including meditation, mindfulness, yoga, and acupuncture, may enhance recovery from alcohol dependence and help ease stress or anxiety linked to it.
Advances in Treatment
It's vital to take an individualized approach to caring for patients with alcohol withdrawal symptoms, as symptoms and their severity vary from person to person.
Studies stress the importance of continued research and public health initiatives that enhance personalized patient care, improve delirium tremens outcomes, and combat alcohol-related harm.
The researchers suggest efforts be directed at early intervention, prevention, awareness, and long-term alcohol dependence treatment.
Managing and Preventing Delirium Tremens
Effectively managing and preventing delirium tremens can save lives.
Strategies for Management
Managing delirium tremens includes immediate care during periods of withdrawal and long-term support and rehabilitation. The short-term goal is to save a patient's life, reduce symptoms, and prevent complications.
During a hospital stay, the healthcare team regularly checks electrolyte levels, body fluid levels, temperature, breathing, pulse, blood pressure, and other vital signs.
Medications given help patients stay relaxed and calm, reduce tremors or seizures, and help treat mental health disorders.
After recovery from delirium tremens, long-term preventive care typically involves abstaining from alcohol, counseling, and support groups, as well as treatment for any coexisting medical problems (liver disease, heart disease, nerve problems, brain diseases, etc.).
Preventive Measures
The only surefire way to prevent delirium tremens is to avoid alcohol entirely. Other ways to reduce its risk include limiting alcohol consumption to 2 drinks daily (or less) for men and 1 drink daily for women.
See a healthcare provider if you're a heavy drinker and need help safely quitting your habit.
Early intervention strategies, education, and awareness significantly reduce the risk of delirium tremens and the chance it becomes fatal.
Support Systems
Family and community support are vital to recovering from alcohol dependence. Examples of well-known support groups include:
- Alcoholics Anonymous
- SMART Recovery
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Al-Anon Family Groups
- National Institute on Alcohol Abuse and Alcoholism
Ask your provider about support groups and counseling services near you to safely and effectively withdraw from alcohol — and avoid relapse.
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Key Takeaways
- Delirium tremens is a severe form of alcohol withdrawal that's more common among heavy drinkers and requires immediate medical attention.
- It's a severe concern that's classified as a medical emergency, as it can become life-threatening if untreated.
- Delirium tremens is characterized by tremors, hallucinations, seizures, confusion, disorientation, and more.
- Alcohol misuse treatment approaches include immediate life-saving care, medication management, nutritional support, substance abuse recovery, counseling, and support groups.
- Comprehensive care and global cooperation in managing delirium tremens is critical.
- Consider reading related articles, subscribing to our newsletter, and leaving a comment with your experiences or questions below!
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