What are the severe consequences of Delirium Tremens (DTs)?

From the Guidelines

Delirium tremens (DTs) is a severe and potentially life-threatening complication of alcohol withdrawal that can lead to multiple dangerous consequences if untreated, including cardiovascular collapse, respiratory failure, and severe seizures, with mortality rates reaching 5-15% without proper medical intervention. The most serious outcomes of DTs include:

• Cardiovascular collapse
• Respiratory failure
• Severe seizures that may progress to status epilepticus
• Hyperthermia with temperatures exceeding 104°F
• Profound electrolyte imbalances particularly involving sodium, potassium, and magnesium Patients may experience acute kidney injury from rhabdomyolysis, dehydration, and metabolic acidosis. Neurologically, DTs can cause permanent cognitive damage, Wernicke-Korsakoff syndrome (especially without thiamine supplementation), and in some cases, cerebral edema. The autonomic instability during DTs places enormous stress on the cardiovascular system, potentially triggering arrhythmias, myocardial infarction, or stroke in vulnerable individuals. According to the most recent study 1, delirium is a medical emergency that requires early detection and accurate diagnosis to prevent high mortality rates. Proper medical intervention, including benzodiazepines (typically diazepam 5-10mg IV or lorazepam 2-4mg IV repeated as needed), fluid resuscitation, thiamine supplementation (100mg IV/IM daily), and close monitoring in an intensive care setting, is crucial to prevent these severe consequences. The pathophysiology involves excessive central nervous system excitation after removal of alcohol's chronic depressive effects, with massive catecholamine release and glutamate rebound contributing to the dangerous autonomic instability and neurotoxicity, as discussed in 1.

From the FDA Drug Label

More severe acute withdrawal signs and symptoms, including life-threatening reactions, have included catatonia, convulsions, delirium tremens, depression, hallucinations, mania, psychosis, seizures, and suicidality

• The severe consequences of Delirium Tremens (DTs) include:
  • Life-threatening reactions
  • Convulsions
  • Seizures
  • Suicidality
  • Other severe symptoms such as catatonia, hallucinations, mania, psychosis, and depression 2

From the Research

Severe Consequences of Delirium Tremens (DTs)

• Delirium Tremens (DT) is a severe spectrum of alcohol withdrawal that can potentially result in death if not managed promptly and adequately 3
• The mortality rate of DT is around 8% 4
• DT presents with a combination of severe alcohol withdrawal symptoms and symptoms of delirium with agitation and sometimes hallucination 3
• If left untreated or poorly managed, DT can lead to severe complications, including respiratory depression, pneumonia, and Wernicke's encephalopathy 5

Clinical Presentation and Treatment

• DT is characterized by a combination of severe alcohol withdrawal symptoms, delirium, agitation, and hallucination 3, 6
• Benzodiazepines, such as diazepam and lorazepam, are the mainstay of treatment for DT 3, 4
• In refractory cases, other medications like phenobarbital, propofol, and dexmedetomidine may be used 3, 6, 7
• Treatment should be individualized and closely monitored to prevent complications and ensure optimal outcomes 4, 5

Refractory Delirium Tremens

• Refractory DT is defined by a high requirement of intravenous diazepam with poor control of withdrawal symptoms 4
• Refractory DT requires intensive management and may involve the use of high doses of benzodiazepines or other medications like phenobarbital, propofol, and dexmedetomidine 6, 7
• The use of propofol as adjuvant therapy has been reported to be effective in controlling refractory DT 7