What are the symptoms of delirium tremens?

Symptoms of Delirium Tremens

Delirium tremens (DT) is characterized by altered mental status, disorientation to person/place/time, autonomic nervous system hyperactivity (high fever, tachycardia, hypertension, sweating), and tremor, with symptoms typically peaking 3-5 days after abrupt alcohol cessation. 1

Core Clinical Features

Mental Status Changes

• Altered mental status ranging from confusion and disorientation to agitation, stupor, or coma 1, 2
• Delirium with clouded consciousness and fluctuating symptoms that vary throughout the day, often worsening at night 1, 2
• Disorientation to person, place, or time 1
• Intra- and inter-daily variations in symptom severity 1

Autonomic Nervous System Activation

• High fever (hyperthermia) 1
• Tachycardia (rapid heart rate) 1, 2
• Hypertension (elevated blood pressure) 1, 2
• Profuse sweating (diaphoresis) 1, 2
• Hand tremor 1

Neurological and Motor Symptoms

• Tremor (characteristic shaking, especially of the hands) 1, 2
• Seizures (alcohol withdrawal seizures may occur) 1
• Disturbed thought processes 2
• Sensory disturbances 2

Perceptual Disturbances

• Hallucinations (visual hallucinations are particularly common) 1
• Misperceptions 1
• Delusions 1

Gastrointestinal Symptoms

• Nausea 1
• Vomiting 1

Behavioral Changes

• Inappropriate or unsafe behavior 1
• Emotional lability 1
• Agitation or restlessness 2, 3

Timing and Course

• Symptoms typically occur 6-24 hours following abrupt cessation of alcohol consumption in those who habitually drink excessively 1
• Symptoms are typically worst at 3-5 days following abrupt alcohol cessation 1
• The condition follows a fluctuating course with symptoms waxing and waning throughout the day 2
• Disturbed sleep-wake cycle with circadian rhythm disruption 1, 2

Critical Complications to Monitor

Careful evaluation is necessary for potentially life-threatening comorbidities including 1:

• Dehydration
• Electrolyte imbalance
• Renal failure
• Head trauma
• Infection
• Gastrointestinal bleeding
• Pancreatitis
• Liver failure

Important Clinical Distinctions

• Frequent monitoring of vital signs is necessary given the autonomic instability 1
• DT can result in death due to malignant arrhythmia, respiratory arrest, sepsis, severe electrolyte disturbance, or prolonged seizures unless recognized and treated adequately 2
• The prevalence of DT is <1% in the general population and nearly 2% in patients with alcohol dependence 3