Delirium tremens
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Delirium tremens is a short-term episode of delirium and severe form of alcohol withdrawal involving sudden mental and neurological changes in the affected individual. The condition is also known as DT’s, the shakes, rum fits and jitterbugs.


Delirium tremens symptoms occur due to the toxic effects of alcohol on the nervous system and the brain and usually appear after a period of heavy alcohol consumption. History of alcohol use usually ranges for about 10 years or more. The condition is considered life-threatening and a medical emergency requiring immediate attention. Delirium tremens occurs in 5% to 10% of all alcoholic individuals with a 5% mortality rate with treatment and 35% mortality rate without treatment.

In other cases, the condition may also stem from withdrawal from benzodiazepines or barbiturates. Compared to long-term alcohol use, the time required to develop drug withdrawal symptoms is not as much. However, compound intake of both alcohol and tranquilizers are extremely dangerous and fatal. The condition should be treated immediately since 30% of all cases are considered fatal. Delirium tremens affects the brain quickly resulting to the production of GABA and serotonin since the body attempts to seek balance during sobriety.


The most common symptoms of the condition are confusion, agitation, disorientation and severe autonomic instability like hypertension, fever and tachycardia. Individuals may also experience intense visual or auditory hallucinations of insects, rats and snakes. Tactile hallucinations may also be present as evidenced by the formication phenomenon. Affected patients may experience severe tremors in the extremities together with panic attacks, anxiety and paranoia. Take note that symptoms will subside with proper intervention and once the body starts to adapt to the changes. Some cognitive changes may also be permanent even after the patients has been successfully treated.

Delirium tremens has autonomic hyperactivity in the extreme state as evidenced by high blood pressure, increased rate of breathing and rapid pulse. About half of all patients develop a fever while some experience seizures. Other associated symptoms include shakiness, nervousness, excitability, anxiety, irritability, emotional volatility, sudden mood swings, depression, fatigue, lack of concentration or focus, palpitations, headache, excessive sweating, nausea, vomiting, loss of appetite, insomnia, increased activity, restlessness, pale skin, fear, agitation, deep sleep lasting a day or more, stupor, lethargy, stomach pain and chest pain.


Metabolic disorders are the most common cause of delirium tremens. Metabolic encephalopathy is a type of delirium accounting for 20% to 40% of all cases which stems from organ failure. Underlying conditions may also cause the condition such as diabetes mellitus, hyperthyroidism, hypothyroidism, vitamin deficiency, electrolyte and fluid imbalance and severe dehydration. Drug intoxication or intoxication confusional state makes up for 20% of all cases as a result of overdose, side effects or deliberate intake. Some drug can cause delirium as a side effect such as anticholinergics like atropine, diphenhydramine which is an anti-allergy medication, sedatives, antidepressants, anticonvulsants, NSAIDs, corticosteroids, anticancer drugs, lithium and antibiotics.
Delirium tremens
Image: Delirium tremens

Long term alcohol intake wherein individuals have consumed 7 to 8 pints of alcohol for several months will trigger withdrawal responses once consumption stops. Drug withdrawal can also cause delirium tremens including psychoactive prescription medications. Other substances that can cause the condition are poisons that lead to toxic encephalopathy, carbon monoxide, refrigerants, heavy metals like lead, insecticides, animal venoms and mushrooms. Other conditions can lead to withdrawal symptoms like infection, head trauma, epilepsy, brain tumor, hypoxemia and low carbon dioxide level.

Excessive alcohol intake predisposes individuals to a lot of nutritional deficiencies and malnutrition. Megaloblastic anemia may also result as well as decreased folate absorption due to alcohol-induced anorexia. Underlying conditions can cause differences in folate storage and absorption such as hepatitis and liver cirrhosis. These can be quite harmful to growing fetuses and pregnant women. Those who have a history of delirium tremens are also prone for recurrence.

Pharmacotherapy is highly useful to decrease the symptoms. Patients are usually sedated with benzodiazepines like diazepam, lorazepam or oxazepam. Extreme cases may require small amounts of haloperidol or stronger benzodiazepines like midazolam and temazepam. Alternative medications include paraldehyde and clomethiazole. These used to be used frequently before until the rise of benzodiazepines. Acamprosate is used to augment treatment and prevent relapse.

The environment should also be controlled for those experiencing tactile and visual hallucination by providing good light and relaxing surroundings. Seizures are treated accordingly to help patient stay safe from accidents and falls. Initial signs and symptoms need to be attended to through early intervention such as alcohol abstinence, providing enough nutrition, electrolytes and fluids to patients and providing adequate rest. A lot of patients are usually dehydrated and lacks a lot of important vitamins and minerals. They should be given enough magnesium, thiamine, zinc and iron.

Delirium tremens patients should immediately be brought to a hospital where they will be taken in the ICU or intensive care unit. Constant monitoring is important to ensure that heart rate, breathing and blood pressure are within normal range. Most of the individuals without terminal illness successfully recover from delirium tremens. However, not all cognitive abilities may return to normal since some impairments are considered permanent.


The most obvious prevention method would be to stay clear of harmful drugs and excessive alcohol intake. People with an alcoholic sibling or parent are more likely to develop the same problem compared to others. Individuals should make sure that they only consume alcohol in moderate amounts or avoid it completely. External factors may also be controlled and managed by reducing exposure to insecticides, heavy metals and other substances known to cause the condition.

Delirium tremens can be prevented for good by following medical prescriptions, consulting a physician and having a regular checkup annually. Proper nutrition with enough vitamins and minerals, regular exercise and finding healthy means of leisure will help individuals stay away from recreational drugs and drinking. If a person needs to take any of the drugs known to cause delirium tremens as a side effect, he or she should consume only under the supervision of a licensed professional.
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