From the Guidelines
Delirium tremens (DTs) is a severe form of alcohol withdrawal that typically occurs 48-72 hours after the last drink, though it can appear as early as 24 hours or as late as 10 days after cessation in heavy drinkers. The primary symptoms of delirium tremens include:
- Confusion
- Disorientation
- Agitation
- Severe tremors
- Hallucinations (often visual or tactile)
- Fever
- Seizures
- Elevated heart rate
- High blood pressure
- Profuse sweating
- Insomnia Patients may experience terrifying hallucinations such as insects crawling on their skin or see threatening figures. DTs is a medical emergency with a mortality rate of 1-4% even with treatment, as noted in previous studies 1, but more recent guidelines do not provide a specific mortality rate 1. It occurs in approximately 5% of people experiencing alcohol withdrawal, primarily affecting those with a history of heavy, prolonged alcohol use, previous withdrawal episodes, or concurrent medical conditions. The symptoms result from the brain's hyperexcitability after alcohol's depressant effects are removed, causing an imbalance in neurotransmitters, particularly increased glutamate activity and decreased GABA inhibition. Anyone suspected of experiencing DTs requires immediate medical attention as the condition can be life-threatening if untreated, and benzodiazepines are considered the ‘gold standard’ treatment for AWS, given their efficacy for reducing both withdrawal symptoms and the risk of seizures and/or delirium tremens 1.
From the Research
Symptoms of Delirium Tremens
- Delirium Tremens (DT) presents with a combination of severe alcohol withdrawal symptoms and symptoms of delirium with agitation and sometimes hallucination 2
- Symptoms include severe alcohol withdrawal symptoms, delirium, agitation, and hallucination
Time Frame from Last Drink
- The time frame from the last drink to the occurrence of delirium tremens is not explicitly stated in the provided studies
- However, it is known that delirium tremens typically occurs in the most severe spectrum of alcohol withdrawal, which can occur after a period of heavy drinking has stopped 2
Treatment and Management
- Benzodiazepines are the mainstay of treatment for delirium tremens, with diazepam and lorazepam being preferred benzodiazepines 2
- In benzodiazepine refractory cases, phenobarbital, propofol, and dexmedetomidine could be used 2
- The use of benzodiazepines in the treatment of delirium is controversial, and current guidelines do not recommend their use for this indication 3