What is the time window for developing delirium tremens (DTs)?

From the Guidelines

Delirium tremens typically occurs within 48 to 72 hours after the last alcoholic drink, though it can begin as early as 24 hours or as late as 10 days after alcohol cessation in heavy drinkers. The time frame for delirium tremens (DTs) is a critical aspect of managing alcohol withdrawal syndrome (AWS), as highlighted in the EASL clinical practice guidelines for the management of alcohol-related liver disease 1. According to these guidelines, AWS can progress to more severe forms, including DTs, seizures, coma, cardiac arrest, and death. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) score is useful in assessing the severity of AWS, with a score ≥15 indicating severe AWS, which may progress to DTs. Benzodiazepines, such as diazepam, lorazepam, or chlordiazepoxide, are considered the gold standard treatment for AWS and DTs, given their efficacy in reducing withdrawal symptoms and the risk of seizures and/or DTs 1. Some key points to consider in the management of DTs include:

• The condition usually lasts for 2 to 3 days, but symptoms can persist for up to a week in severe cases
• Treatment typically involves benzodiazepines, with dosing adjusted based on symptom severity
• Supportive care includes IV fluids, thiamine, folate, and electrolyte replacement, particularly magnesium and potassium
• Delayed treatment can lead to significant complications, including seizures, cardiac arrhythmias, and death, with mortality rates of 1-4% even with treatment 1. Understanding the time window for DTs is crucial to provide timely and effective treatment, reducing the risk of complications and improving patient outcomes.

From the Research

Time Window for Delirium Tremens

• The time window for being in delirium tremens is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• Delirium tremens (DT) is a specific type of delirium occurring in patients who are in alcohol withdrawal states, and its treatment is best achieved by the use of intravenous diazepam administered at frequent intervals while closely monitoring the patient during the procedure 2.
• Refractory DT is defined by a high requirement of intravenous diazepam with poor control of withdrawal symptoms 2.
• The duration of delirium episode is not reported in the studies 4, 5.
• The use of benzodiazepines, such as lorazepam, is commonly used to treat symptoms of delirium, but conflicting data exist on the effect of these drugs on the outcomes of delirium 3, 4, 5.
• Further research is required to determine the time window for being in delirium tremens and the effectiveness of benzodiazepines in treating delirium 4, 6.

Delirium Tremens Treatment

• Treatment of DT is best achieved by the use of intravenous diazepam administered at frequent intervals while closely monitoring the patient during the procedure 2.
• Benzodiazepines, such as lorazepam, are commonly used to treat symptoms of delirium, but conflicting data exist on the effect of these drugs on the outcomes of delirium 3, 4, 5.
• The use of antipsychotics, with or without lorazepam, during delirium is associated with increased risks of poor outcomes 5.
• Further investigation is needed to clarify the association between the use of benzodiazepines and antipsychotics in delirium treatment 5.

Benzodiazepines and Delirium

• Benzodiazepines are commonly used to treat symptoms of delirium, but conflicting data exist on the effect of these drugs on the outcomes of delirium 3, 4, 5.
• The use of benzodiazepines, such as lorazepam, is associated with increased risks of poor outcomes in older patients with delirium 5.
• Further research is required to determine the effectiveness of benzodiazepines in treating delirium and the potential risks associated with their use 4, 6.