Delirium Tremens (DTs): Causes, Symptoms & Treatment

Delirium tremens (DTs) is a rare but serious consequence of alcohol withdrawal. About 2% of people with alcohol dependence will develop delirium tremens if they try to quit drinking cold turkey.[1] 

People with DTs experience hallucinations, fast heart rates, changes in blood pressure and other symptoms that can progress to life-threatening seizures and even death.

Anyone with an alcohol use disorder (AUD) should talk to a doctor before quitting drinking. Medications and close monitoring can ensure your medical team can step in and help you if something goes wrong. 

What Is Delirium Tremens?

Delirium tremens (DTs) is a syndrome that occurs in chronic alcohol misusers who quit drinking abruptly. It was first recognized as a disorder during the 1800s, but doctors have learned a lot about it since then.[2]

With medication management and careful monitoring, people with DTs can get better. But anyone with DTs should consider this a medical emergency and get treatment right away. 

Common Delirium Tremens Symptoms

People experiencing alcohol withdrawal often feel anxious, shaky and restless. If these symptoms are left untreated, they can worsen over hours to days and progress to delirium tremens.

People with DTs will develop the following:

• Hallucinations: Typically, these are visual. People will see things others can’t. While they may know their visions aren’t real, they may be unable to snap to reality. 
• Cardiovascular symptoms: Their blood vessels dilate, so they look flushed and sweaty. Their hearts race and they may seem out of breath. 
• Seizures: In severe cases, people develop grand mal seizures that last a few minutes before repeating. These can be life-threatening episodes.

Symptoms of DTs typically appear three to five days after the person stops drinking, and they can last for two to six days. Some people even have symptoms for weeks.[3]

Causes of Delirium Tremens

Sedative drugs like alcohol affect neurotransmitters, which are chemicals that your brain uses to connect one cell to another, and ultimately inhibits brain activity. In time, brain cells become accustomed to this slow activity. 

When you stop drinking abruptly, the limits placed on neurotransmitters disappear. Brain cells spring to life, and they begin communicating. Sometimes, they overreact. 

When brain cells are overactive, they trigger a cascade of symptoms throughout the central nervous system, causing symptoms we call the DTs. 

How Much Alcohol Do You Need to Drink to Develop DTs?

There’s no one-to-one relationship between alcohol consumed and DTs symptoms. 

Some people drink heavily for years and never develop severe alcohol withdrawal, while others drink less and develop severe symptoms and DTs.[4] The risk involves genetic or biological roots that we currently don’t understand well.

The biggest risk factor for delirium tremens is having a history of prior severe alcohol withdrawal.[5] If you’ve tried to quit cold turkey before and had shaking, tremors, hallucinations and other troublesome signs, you’re at a high risk of developing DTs. Consult with a medical professional before trying to quit. 

When to Call a Doctor

Delirium tremens is serious, and estimates suggest up to 8% of people who develop it die.[6] Prevention is critical.

Always contact a doctor before you consider attempting sobriety if you’ve been drinking for a while. Pull together a plan to control your symptoms and monitor your progress. You may need to check into a detoxification facility to get around-the-clock care, so you can transition to sobriety safely.

Always visit the emergency room if you develop DTs symptoms. When you arrive, tell the team the following:

• How much you typically drink
• How long you’ve struggled with your alcohol use
• What happened in prior times when you tried to quit
• The date and time of your last drink

Make sure that the team knows you’re dealing with DTs and you want help.

Treating Delirium Tremens

If you have a history of an alcohol use disorder, your treatment team can monitor you closely while you attempt to detox.

Most cases of moderate to severe alcohol withdrawal respond to benzodiazepine medications, which are central nervous system depressants that work in similar ways to alcohol.[7] 

Overexcited brain cells calm down, and this stops symptoms and prevents seizures and progression to more serious withdrawal. These medications can be taken either orally or through an IV. They can be dosed as needed or on a scheduled basis.

Some people don’t respond to treatment with standard doses of benzodiazepines, and doctors must take significant measures. Close to half of people admitted to a medical intensive care unit for DTs require intubation.[8] 

Is Delirium Tremens Reversible?

With monitoring and treatment, people with DTs can get better and fully recover. Brain cells begin functioning normally, and problems fade. 

Without treatment, DTs tend to worsen. Sometimes, it progresses to seizures that can be life-threatening. Seizures like this can also be treated, but it’s best to get treatment before they start. 

Life After DTs

The help you get in a detoxification program may save your life, but it won’t keep you from drinking again. 

You’ll need to work with a treatment team to understand your drinking triggers and strategies to prevent returning to alcohol use. 

Once you get through acute detox, it’s time to start thinking about your long-term plan to maintain abstinence. You could use medications and behavioral therapies to support your long-term recovery. 

How to Prevent Delirium Tremens

The best way to prevent delirium tremens is to avoid or seriously limit how much you drink alcohol from the start. If you never develop an alcohol use disorder, you likely won’t develop significant withdrawal symptoms when you quit. 

If you already have an alcohol use disorder, talk with your doctor before you quit your use. Together, you can determine a safe way to stop drinking and stay sober. 

Delirium Tremens FAQs

Is delirium tremens an emergency?

Yes. Because the mortality rate of people experiencing DTs is so high, it is considered a medical emergency. Treatment may require admission to the intensive care unit for close monitoring and heavy administration of medications to control and prevent seizure activity.

What should I do if I experience severe alcohol withdrawal symptoms?

Anyone with a history of severe alcohol withdrawal or experiencing symptoms of DTs should go to a hospital emergency room immediately. And anyone who feels uncomfortable while withdrawing from alcohol should do the same. Early detection and treatment could save that person’s life.