Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes.
DTs; Alcohol withdrawal – delirium tremens
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 is most common in people who have a history of
Symptoms most often occur within 48-96 hours after the last drink. However, they may occur up to 7 – 10 days after the last drink.
Symptoms may get worse quickly, and can include:
- Body tremors
- Changes in mental function
- Agitation, irritability
- Deep sleep that lasts for a day or longer
Hallucinations(seeing or feeling things that are not really there)
- Increased activity
mood changes Restlessness, excitement
- Sensitivity to light, sound, touch
Stupor, sleepiness, fatigue
Seizures (may occur without other symptoms of DTs)
- Most common in first 12 – 48 hours after last drink
- Most common in people with past complications from alcohol withdrawal
generalized tonic-clonic seizures
Symptoms of alcohol withdrawal, including:
Anxiety Depression Fatigue
- Feeling jumpy or nervous
- Feeling shaky
- Insomnia (difficulty falling and staying asleep)
- Irritability or excitability
Loss of appetite Nausea Pale skin Palpitations(sensation of feeling the heart beat)
- Rapid emotional changes
Sweating, especially on the palms of the hands or the face
Other symptoms that may occur:
Chest pain Fever Stomach pain
Exams and Tests
Delirium tremens is a medical emergency.
The health care provider will perform a physical exam. Signs may include:
Increased startle reflex
Problems with eye muscle movement
Rapid heart rate
Rapid muscle tremors
The following tests may be done:
Blood magnesium level
Blood phosphate level
Comprehensive metabolic panel Electrocardiogram(ECG)
The goals of treatment are to:
Save the person’s life
A hospital stay is needed. The health care team will regularly check:
Blood chemistry results, such as
Body fluid levels
Vital signs (temperature, pulse, rate of breathing, blood pressure)
Symptoms such as agitation, seizures, and irregular heartbeat are treated with the following medications:
- Sedatives such as diazepam or lorazepam
- Anticonvulsants such as phenobarbital
The patient may need to be put into a sedated state for a week or more until withdrawal and DTs are finished. Benzodiazepine medications such as diazepam or lorazepam also help treat seizures, anxiety, and tremors.
Antipsychotic medications such as haloperidol may sometimes be needed for persons with severe psychotic symptoms, especially if they have an underlying problem such as schizophrenia. However, these drugs should be avoided if possible because they may contribute to seizures.
Long-term preventive treatment should begin after the patient recovers from immediate symptoms. This may involve a “drying out” period, in which no alcohol is allowed. Total and lifelong avoidance of alcohol (abstinence) is recommended for most people who go through withdrawal. The person should receive treatment for alcohol use or alcoholism, including:
Support groups (such as Alcoholics Anonymous)
The patient should be tested, and if needed, treated for other medical problems that can occur with alcohol use. Such problems may include:
Alcoholic liver disease
For additional resources, see
Delirium tremens is serious and may be life-threatening. Some symptoms related to alcohol withdrawal may last for a year or more, including:
Emotional mood swings
- Injury from falls during seizures
- Injury to self or others caused by mental state (confusion/delirium)
- Irregular heartbeat, may be life threatening
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.
Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.
For more information, see: