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Delirium Tremens: Causes, Effects and Treatment

Delirium tremens (DTs) have been well-known among those with alcohol use disorders, but research continues to help medical professionals avoid the perils of this life-threatening disorder. Alcohol withdrawal is challenging to manage, but with medical monitoring and guidance through detox, the unfortunate diagnosis of delirium tremens may be treatable with immediate intervention.

Studies focusing on extreme addiction levels recognize how important it is to assess patients for the possibility of delirium tremens. As a result, medical professionals concentrate on pinpointing the severity of alcohol withdrawal syndrome (AWS), using standardized assessments before detox occurs.  

What is Delirium Tremens?

Those with a history of chronic alcohol use or long periods of heavy drinking may experience delirium tremens after being in withdrawal for a few days. Alcohol withdrawal can be dangerous, even life-threatening. The symptoms can range in severity, beginning with irritability and global confusion, leading to tremors, nausea, vomiting, and finally, seizures and possibly cardiac involvement.

Not everyone in alcohol withdrawal will experience the DTs, but those with excessive and long-term alcohol abuse are at greater risk. Potentially fatal, delirium tremens are not permanent. The typical length of this condition is 3 to 4 days, but in extreme cases, it could extend as long as 8 days.

Medical monitoring will recognize the symptoms early on so that treatment can be administered immediately. Those who leave detox to continue to drink alcohol are more apt to experience delirium tremens in future detox situations. 

Risk Factors for Delirium Tremens

Excessive alcohol intake controls the activity of the central nervous system, causing brain functioning to slow down. The resulting experience is a feeling of sedation and lessened anxiety. As the brain adjusts to continuing alcohol use, tolerance for alcohol continues to build.

Once dependence occurs, it is significantly difficult for the brain to function without continuing the consumption of alcohol. The risk lies in the brain’s reaction to no more alcohol to work with. A state of hyperarousal can arise when alcohol is no longer a messenger.

When withdrawal symptoms begin, there are specific components of excessive alcohol consumption that can cause a risk for delirium tremens to develop. The assessment team and medical personnel in a qualified alcohol rehab program will examine the elements of the alcohol use disorder to be able to determine if DTs are an imminent threat through detox. 

Various assessment tools can determine the likelihood that extreme withdrawal symptoms could occur. The following factors can increase the risk of delirium tremens during detox:

  • Higher amounts of alcohol consumption before withdrawal
  • Previous attempts to detox and previous severe withdrawal symptoms
  • Previous experience with delirium tremens in withdrawal
  • Severe underlying health conditions
  • Old age
  • Mental health conditions
  • Poor general health and poor diet
  • The use of other medications or supplements

Signs and Effects of DT

The National Institute on Alcohol Abuse and Alcoholism reveals that the dangers are great with alcohol withdrawal. The Journal of Emergency Medicine reports to the institute approximately 260,000 emergency department visits are due to alcohol withdrawal. They also account for alcohol withdrawal, contributing to 850 deaths each year.

Medical professionals monitoring alcohol withdrawals regularly concur that the signs and symptoms of delirium tremens don’t just suddenly appear. Still, the condition is a progression of events leading to the DTs. 

Within 2 to 3 days after the cessation of alcohol consumption, medical professionals can assess major factors involving the signs and symptoms of withdrawal to determine if delirium tremens could evolve. As withdrawal progresses and intensifies, the medical record can alert those monitoring the patient that the possibility of delirium tremens is high. The following signs and symptoms are indicative of those possibly developing DTs. 

Typical withdrawal symptoms indicating the possibility of DTs occurring are the following:

  • Agitation, aggression, and irritability
  • Global confusion (interruption of short-term memory abilities)
  • Severe autonomic hyperactivity, such as trembling, sweating, tachycardia, nausea and vomiting
  • Impairment of consciousness, tremors, or seizures
  • Visual, tactical, or auditory hallucinations

The timeline for delirium tremens fluctuates with each case. Some symptoms last longer than others, but the typical alcohol withdrawal timeline begins within 6 to 24 hours after long-term heavy drinking is stopped.

As the initial symptoms intensify and further assessments begin to reveal that 12 to 48 hours after the last drink, hallucinations, and seizures can indicate DTS may occur. Generally, within 3 to 5 days of dangerous and intense symptoms, delirium tremens begin to resolve, although some cases can continue for 8 to 10 days. 

Delirium Tremens Treatment

The treatment begins once the patient is determined to be experiencing the DTs. Medical professionals must act quickly to treat the condition as an emergency. Stabilization can occur through medication-assisted treatment and further intensive monitoring. It is imperative when choosing an alcohol treatment center to consider the need for around-the-clock medical monitoring and the option of using medication to ease withdrawal symptoms. 

Typical medications for the treatment of severe withdrawal symptoms and delirium tremens include;

  • Benzos: Ativan, Valium, or Librium are effective in managing most alcohol withdrawal symptoms, including delirium tremens
  • Barbiturates: Phenobarbital may be a supplemental medication when benzos are not quite enough
  • Antipsychotics: Haldol can be a solid treatment for behavioral issues, agitation, and psychotic symptoms such as hallucinations. 

The goal in medically managing alcohol withdrawal symptoms is to lessen the intensity of the withdrawal symptoms. In the process, the team can identify and treat medical and mental co-occurring disorders and continue to initiate treatment-driven protocols to reach sobriety and begin therapy.

Once the emergency comes to an end, therapy can begin to further the journey toward sobriety. Successful recovery from an alcohol use disorder is possible. 

Resolve Fears of Alcohol Withdrawal with Professional Treatment

Fear of the unknown is natural and understandable. Tennessee Valley Recovery Center understands the anxiety of ending an alcohol use disorder and the fear of delirium tremens. The qualified medical and treatment professionals at Tennessee Valley Recovery offer many options for resolving addiction.

Contact the center today to quickly move on to a sober horizon.