Delirium tremens or DTs is the most severe form of alcohol withdrawal that can be deadly if untreated.
What is Delirium Tremens?
Studies show that approximately 50% of those who abuse alcohol will experience some kind of alcohol withdrawal symptoms when they quit drinking.
Among those presenting with withdrawal symptoms, roughly 5% will experience delirium tremens.
In most cases, DTs manifest in those with a history of chronic alcoholism.
Delirium tremens is also more common among those who have previously experienced severe withdrawal symptoms when intake is moderated or discontinued.
Frequently, DTs will crop up after a sustained period of heavy drinking.
Data shows that the symptoms typically associated with alcohol withdrawal progress gradually, changing over the day, and potentially becoming DTs in the most severe cases of alcohol withdrawal.
Is Delirium Tremens a Medical Emergency?
While delirium tremens is quite rare, affecting less than 1 in 20 of those who stop drinking, it can also be fatal if left untreated.
With the symptoms of DTs differing from those experienced during alcohol withdrawal and symptoms unfolding over a substantially different timeline, it pays to familiarize yourself with the worst possible outcome of alcohol withdrawal.
Symptoms of potential delirium tremens include:
- Rapid muscle tremors
- Irregular heartbeat
- Profuse sweating
When do delirium tremens start, then?
Delirium Tremens Timeline
Delirium tremens tend to progress along a broadly similar timeline. Some symptoms will be fleeting, while others will persist.
To better understand what occurs with DTs, we’ll illustrate a typical timeline for alcohol withdrawal. This will help you to put delirium tremens into a clearer perspective on this broader timeline.
In most cases, alcohol withdrawal begins anywhere from 6 to 12 hours after the last alcoholic drink, unfolding over four discrete stages.
First stage of alcohol withdrawal
The first minor symptoms of alcohol withdrawal can include any or all of the following:
- Irregular heart rate
- Raised heart rate
- Loss of appetite
Second stage of alcohol withdrawal
During the first 24 hours after the last alcoholic drink, some people in withdrawal will experience hallucinations – more on these below.
If hallucinations present, they should dissipate no more than 48 hours after your last drink.
Third stage of alcohol withdrawal
When seizures accompany alcohol withdrawal, they typically occur from 24 hours to 48 hours after the last drink.
Fourth stage of alcohol withdrawal
At any point from 48 hours to 72 hours after the last alcoholic drink, the symptoms of delirium tremens can manifest.
Delirium tremens symptoms will usually peak after 5 days, subsiding after a week or so.
You can expect to encounter the more severe symptoms associated with DTs – seizures and hallucinations – anywhere from 12 hours to 48 hours after your last alcoholic drink.
Some lingering symptoms of DTS may persist for 10 days or more, but most symptoms should be resolved within 7 days.
Delirium Tremens Symptoms
Most symptoms of DTs manifest and dissipate in the 96 hours after your last alcoholic drink.
In some rare cases, the symptoms of delirium tremens only appear 7 to 10 days after the last alcoholic drink.
As soon as these DTs symptoms appear, they will usually rapidly worsen. The most common symptoms include:
- Acute sensitivity to light
- Rapid mood changes
- Body tremors
- Deep sleep
- Rapid mood changes
- Spikes of energy
- Changes to mental function
Seizures are associated with delirium tremens, and these can sometimes present with no other symptoms of DTs developing.
If seizures occur, these will typically present in the first 12 to 48 hours of sobriety. These grand-mal seizures are more common in those with previous adverse experiences withdrawing from alcohol.
Hallucinations are perhaps the most distressing of all delirium tremens symptoms.
You could encounter any of the following type of hallucinations:
- Visual hallucinations: You see things that do not exist
- Tactile hallucinations: You feel a sense of itching or burning, or sometimes numbness, that is not really occurring
- Auditory hallucinations: You hear sounds that do not exist
Can Delirium Tremens Cause Brain Damage?
There is a possibility you could sustain brain damage during delirium tremens if you are not in a medical setting and you have a seizure that remains untreated.
For anyone with severe alcohol use disorder, it is worth considering withdrawing from alcohol in a dedicated medical detox center.
Delirium Tremens Treatment
For anyone in danger of experiencing more severe symptoms during alcohol withdrawal, it is advisable to seek medical treatment rather than attempting a home detox.
If you engage with treatment at a hospital, an inpatient treatment center, or a medical detox center, treatment for delirium tremens can begin, with the condition treated as a medical emergency if it presents. Delirium tremens requires continuous medical monitoring. In some more severe cases of delirium tremens, you could require treatment in an ICU.
There are three core goals of DTs treatment:
- Relieving symptoms
- Preventing complications
- Saving the patient’s life
Your treatment team checks the following:
- Breathing rate
- Blood pressure
- Electrolyte levels
- Body fluid levels
Many medications can effectively soothe some symptoms of delirium tremens, including:
- Benzos: Benzodiazepines like Valium and Librium can help to manage all symptoms of alcohol withdrawal, including the symptoms of DTs. Benzos can also help lessen the chance of seizures. You will need large doses of benzodiazepines. The strongly habit-forming nature of benzos mean they are only prescribed for short-term use.
- Barbiturates: If benzodiazepines are ineffective for managing the symptoms of delirium tremens, phenobarbital or other barbiturates may prove effective.
- Antipsychotics: When prescribed in low doses, some antipsychotics such as haloperidol can help manage psychotic symptoms, hallucinations, for instance. Unfortunately, there is a strong risk of side effects with this class of medication.
Any or all of these medications can help to ensure you stay calm until the symptoms of delirium tremens dissipate. This should occur by the end of the first week of sobriety.
If you continue drinking alcohol after withdrawing, you increase your risk of experiencing DTs in the future.
With detox complete, you’ll be ready to engage with outpatient treatment for alcohol use disorder.
Here at The District Recovery Center, our evidence-based programs include both IOPs (intensive outpatient programs) and PHPs (partial hospitalization programs) to help you reclaim the life you lost to alcoholism. Through a combination of MAT (medication-assisted treatment), psychotherapy like CBT or DBT, and counseling, you can build a solid foundation for sustained sobriety.
All you need to do is reach out to TDRC today at 949.570.7600.