Delirium Tremens (DTs): Causes, Symptoms & Treatment

October 10, 2022

Table of Contents

Delirium tremens is the most serious consequence of alcohol withdrawal. 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.

About 2% of people with alcohol dependence will develop delirium tremens if they try to quit cold turkey.[1] This is therefore a rare but serious complication of alcohol withdrawal.

Anyone with an alcohol use disorder 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 while you’re going through detox. 

Common Delirium Tremens Symptoms

People experiencing alcohol withdrawal often feel anxious, tremulous and restless. If these symptoms are left untreated, they can worsen over the course of hours to days to the stage of alcohol withdrawal called delirium tremens (DTs).

People with the 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 for 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. But some people have symptoms for weeks.[2]

How much alcohol do you need to drink to develop Delirium Tremens?

There's no one-to-one relationship between alcohol consumed and DTs symptoms. Surprisingly, some people drink heavily for years and never develop severe alcohol withdrawal, while conversely some individuals may drink comparatively less and develop severe symptoms and DTs. [3] The risk seems to be more genetic or biological than we currently totally understand.

The biggest risk factor for delirium tremens is having a history of prior severe alcohol withdrawal [4]  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 and should consult with a medical professional before trying to quit on your own. 

Treating Delirium Tremens 

If you have a history of 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.[5] These medications are central nervous system depressants, so they work a lot like alcohol. 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 doses 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 with DTs require intubation and admission to the intensive care unit. [6] 

When to Call a Doctor

Delirium tremens are serious, and up to 8% of people who develop it die. [7] Prevention is therefore 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 the DTs and that you want help.

Life After Delirium Tremens

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 prevention strategies for returning to alcohol use. One you make it through acute detox, it's time to start thinking about the long term plan to maintain abstinence. This can mean either medications, behavioral therapies, or ideally both to help support your long term recovery. 

Delirium Tremens FAQs

What is delirium tremens?

Delirium tremens, or DTs, is a cluster of symptoms defined by autonomic instability, changes in blood pressure, seizures, and potentially death that is caused by rapid alcohol withdrawal. 

Is delirium tremens an emergency?

Yes. Because the mortality rate of people who are clinically experiencing DTs is so high, it is considered a medical emergency, and may often 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 am experiencing severe symptoms of Alcohol withdrawal?

Anyone with a history of severe alcohol withdrawal or who is 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.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Delirium Tremens: Assessment and Management. Journal of Clinical and Experimental Hepatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286444/. December 2018. Accessed August 2022. 
  2. 28-Day-Long Delirium Tremens. Journal of Investigative Medicine High-Impact Case Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505229/. January 2019. Accessed August 2022. 
  3. Alcohol Withdrawal in the Setting of Elevated Blood Alcohol Levels. The Primary Care Companion to the Journal of Clinical Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1540391/. 2006. Accessed August 2022. 
  4. Risk for Delirium Tremens in Patients With Alcohol Withdrawal Syndrome. Substance Abuse. https://link.springer.com/article/10.1023/A:1015350005418. 2002. Accessed August 2022.
  5. Delirium Tremens: Assessment and Management. Journal of Clinical and Experimental Hepatology. https://www.sciencedirect.com/science/article/abs/pii/S0973688318300562. December 2018. Accessed August 2022.
  6. A Strategy of Escalating Doses of Benzodiazepines and Phenobarbital Administration Reduces the Need for Mechanical Ventilation in Delirium Tremens. Critical Care Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417045/. August 2012. Accessed August 2022. 
  7. Delirium Tremens. Europe PMC. https://europepmc.org/article/med/25668827. December 2014. Accessed August 2022.

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