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Delirium tremens
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Delirium tremens

Alcohol abuse - delirium tremens; DTs; Alcohol withdrawal - delirium tremens; Alcohol withdrawal delirium

Delirium tremens is a severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.

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Causes

Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food.

Delirium tremens may also be caused by head injury, infection, or illness in people with a history of heavy alcohol use.

It occurs most often in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints (1.8 to 2.4 liters) of wine, 7 to 8 pints (3.3 to 3.8 liters) of beer, or 1 pint (1/2 liter) of "hard" alcohol every day for several months. Delirium tremens also commonly affects people who have used alcohol for more than 10 years.

Symptoms

Symptoms most often occur within 48 to 96 hours after the last drink. But, they may occur 7 to 10 days after the last drink.

Symptoms may get worse quickly, and can include:

Seizures (may occur without other symptoms of DTs):

Symptoms of alcohol withdrawal, including:

Other symptoms that may occur:

Exams and Tests

Delirium tremens is a medical emergency.

The health care provider will perform a physical exam. Signs may include:

The following tests may be done:

Treatment

The goals of treatment are to:

A hospital stay is needed. The health care team will regularly check:

While in the hospital, the person will receive medicines to:

Long-term preventive treatment should begin after the person recovers from DT symptoms. This may involve:

Treatment may be needed for other medical problems that can occur with alcohol use, including:

Support Groups

Attending a support group regularly is a key to recovering from alcohol use.

Outlook (Prognosis)

Delirium tremens is serious and may be life threatening. Some symptoms related to alcohol withdrawal may last for a year or more, including:

Possible Complications

Complications can include:

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms. Delirium tremens is an emergency condition.

If you go to the hospital for another reason, tell the providers if you've been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.

Prevention

Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.

Related Information

Psychosis
Seizures
Alcohol withdrawal
Alcohol use disorder

References

Kelly JF, Renner JA. Alcohol-related disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 26.

Mirijello A, D'Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-365. PMID: 25666543 www.ncbi.nlm.nih.gov/pubmed/25666543.

O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.

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Review Date: 1/10/2019  

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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