Delirium tremens (DTs) is the rapid onset of delirium and confusion usually associated with alcohol withdrawal, but can also be caused by the abrupt discontinuation of benzodiazepines, thienodiazepines and barbiturates in long-term/heavy users. Delirium tremens are a cluster of symptoms, which are potentially fatal. Delirium tremens usually occur three days after discontinuation and can last up to three days. It is reported that they are characteristically worse at night.
Anyone thought to be suffering from the condition requires immediate medical intervention. Due to the potential severity and fatality of their discontinuation, alcohol, benzodiazepines, thienodiazepines and barbiturates are notoriously some of the most difficult and dangerous substances to withdraw from.
The symptoms/effects which may occur include:
- Tremors - Delirium tremens is occassionally associated with severe, uncontrollable tremors of the extremities.
- External hallucinations
- Auditory hallucinations
- Tactile hallucinations - This can include the sensation of an insect crawling on one's skin.
- Fever - This occurs when the temperature reaches above 105 °F (40.5 °C). Over a prolonged period of time, this causes damage to the brain cells. In some circumstances, this may result in death.
- Shaking and shivering
- Increased perspiration
- Abnormal heart rate
- Seizures - This may result in death.
- High blood pressure
- Increased heart rate
- Feelings of impending doom
- Language suppression
Anyone thought to be suffering from the condition requires immediate medical intervention due to the risk of death, with the mortality without treatment being between 15% and 40%.
- Gradually tapering one's intake - Withdrawal can be mitigated by slowly tapering one's dosage of alcohol over a period of days or weeks, which will let receptors recover somewhat before discontinuation. This will lessen the severity of symptoms but likely prolong their duration.
- Benzodiazepines - Benzodiazepines such as diazepam, lorazepam, chlordiazepoxide, and oxazepam are commonly used to treat delirium tremens.
- Haloperidol - The antipsychotic haloperidol may also be used to control symptoms.
- Thiamine - High doses of vitamin thiamine is sometimes recommended.
- Paraldehyde - This is an older medication that is generally not used anymore.
- Acamprosate - This substance is sometimes used in addition to other treatments. It can be continued long-term to reduce the risk of relapse.
- Schuckit, M. A. (27 November 2014). "Recognition and management of withdrawal delirium (delirium tremens)". The New England Journal of Medicine. 371 (22): 2109–2113. doi:10.1056/NEJMra1407298. ISSN 1533-4406.
- Blom, J. D. (8 December 2009). A Dictionary of Hallucinations. Springer Science & Business Media. ISBN 9781441912237.
- Stern, T. A., Gross, A. F., Stern, T. W., Nejad, S. H., Maldonado, J. R. (2010). "Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles"". Primary Care Companion to the Journal of Clinical Psychiatry. 12 (3): PCC.10r00991. doi:10.4088/PCC.10r00991ecr. ISSN 1555-211X.