Delirium Tremens

What is Delirium Tremens?

Delirium tremens is derived from the New Latin word which means “trembling delirium”. It is an extreme form of withdrawal from alcohol. It affects the nervous system of the patient and may cause sudden changes in the brain.

People who drink heavily are all at risk of Delirium tremens (DTs).

When a person suddenly withdraws from alcohol, DTs may occur. This is a medical emergency. Early detection and immediate attention are required in cases like this.

The mortality rate from DTs used to be 35 per cent. However, with the advances in medical treatment, the fatality rate is down to 10 per cent. Alcohol withdrawal should be attempted in a medically-supervised environment rather than trying to withdraw alone.

Symptoms of Delirium Tremens

The symptoms of Delirium tremens often manifest within the first 72 hours after intake of an alcoholic drink. The likelihood of exhibiting DTs reduces considerably after 72 hours. However, there are cases wherein DTs can occur within ten days of last alcohol consumption. The symptoms of Delirium tremens vary.

The healthcare provider needs to perform an exam to determine it. Signs usually include the following:

  • Seizures may happen even without the other accompanying signs of DTs. Seizures are usually the generalized tonic-closure seizure kind wherein violent shaking of the body is noted. It manifests even in people with no medical history of epilepsy. Seizures could occur as early as 6 hours after alcohol withdrawal and up to 48 hours. Violent shaking is often noted in people who have previous complications with the withdrawal of alcohol.
  • The person may sweat profusely, especially on the palms or on the face.
  • There is a heightened excitability, causing the person to get easily startled. The patient may also feel irritable or agitated.
  • Delirium or severe kind of confusion. Those who try to withdraw from alcohol often experience confusion, but with DTs, confusion is more serious.
  • The person experiences irregular beating of the heart, particularly a fast heartbeat.
  • Fast tremors in the muscles are also noted.
  • There are problems when it comes to eye muscle coordination.
  • Hallucinations are also present. Patients are prone to see animals moving like snakes. Some people may hallucinate on seeing animals crawl on their skin.
  • High levels of anxiety often related to a foreboding feeling that something bad will occur.
  • The person may develop high blood pressure, high temperature and a fast pulse.

Aside from the above mentioned symptoms, the person may also undergo signs of alcohol withdrawal such as:

  • Depression
  • Lethargy
  • Vomiting
  • Loss of sleep (cannot fall asleep or stay asleep)
  • Mood swings
  • Appetite loss
  • Headache

Other general symptoms of DTs are:

  • Pain in the chest
  • Stomachache
  • High-grade body temperature

To verify if the symptoms are that of DTs, the medical provider may need to conduct the following tests:

Blood magnesium level

This is a blood test to determine the levels of magnesium in the body. If the body has low magnesium levels, then it indicates alcohol addiction or a possible symptom of DTs. The average level of magnesium in the blood is between 1.7 and 2.2 mg/dL.

Blood phosphate level

As the name implies, it is a blood test that measures the level of phosphate in the blood. A lower rate of phosphate in the blood, or what is referred to as hypophosphatemia, may indicate alcoholism or DTs. The standard level of phosphate in the body ranges from 2.4 to 4.1 mg/dL.

Comprehensive metabolic panel

This is a multiple blood test conducted to determine the chemical balances and rate of metabolism of the body. The result will provide clues on how the liver and kidneys are working.

Electrocardiogram (ECG)

This measures the heart’s electrical action. The expected normal heart rate is between 60 and 100 beats per minute. An ECG will determine if a person has heart ailment or experiences symptoms of DTs.

Electroencephalogram (EEG)

This measures the brain’s electrical activity. EEG determines the health of the nervous system mainly to monitor seizures, delirium, infections, injuries and other abnormal brain activity.

Toxicology screen

This test is used to determine the drugs a person took. A blood test or a urine sample can be utilized for the toxicology screen. This exam can identify the substances a person consumed, mainly to verify signs of DTs.

Causes of Delirium Tremens

In most cases, Delirium tremens occurs after heavy bouts of drinking and then quitting abruptly, particularly if you do not consume food. People who drink heavily for several years and even those who drink for only a few months are at risk of DTs.

Other causes of Delirium tremens include injury to the head, diseases, injuries and infection in individuals who ingest alcohol heavily. People with a history of alcohol withdrawal are prone to DTs too. It often manifests in people who drink every day for months – wine (1.8 to 2.4 liters), beer (3.3 to 3.8 liters) and hard alcohol (0.5 liter). Those who consume alcohol for over ten years are also at risk of DTs.

When a person consumes alcohol daily for an extended period, the body gets used to the level of alcohol in the system, so it finds it hard to cope when it is eliminated. It is hard to determine the precise cause of Delirium tremens. The possible culprit is believed to be interference of alcohol with the regulation of a neurotransmitter referred to as GABA.

Chronic abuse of alcohol causes the body to mistakenly identify alcohol as GABA and responds by decreasing the production of neurotransmitters in the body. When alcohol consumption is abruptly stopped, GABA may not be enough for it to function properly. The GABA neurotransmitter regulates the reaction in the nervous system. Sudden decrease in GABA is dangerous for the nervous system in particular, and the body, in general.

Treatments for Delirium Tremens

The primary goal of treatment for Delirium tremens is to save the person’s life, given the seriousness of the symptoms. The treatment is also geared towards relieving the symptoms of the patient as well as preventing possible complications.

Hospital stay is necessary to monitor the symptoms and to prevent or manage any difficulty. The patient may require being placed in the intensive care unit (ICU). The patient should be assessed for ‘Airway, Breathing and Circulation’ (ABC).

The health provider needs to check the patient regularly – mainly the results of blood chemistry or electrolyte levels, body fluids and the person’s vital signs, which include pulse rate, body temperature, breathing rate, and blood pressure.

Low blood glucose or hypoglycemia should be treated. The patient needs to be sedated with a benzodiazepine. Diazepam works immediately. Other psychoactive drugs that can be used include Librium and Valium. These drugs help lower the excitability of the person’s nervous system that causes the DTs signs to manifest.

Make sure that the patient is calm to prevent the onset of anxiety and hallucinations. Keep the environment peaceful. The patient should also be sedated until the symptoms of DTs have passed. If the patient has mental disorders, these should also be treated as they aggravate DTs symptoms.

Barbiturates medicine may be added to the prescribed benzodiazepine. Patients with Delirium tremens may also develop Wernicke’s encephalopathy. This condition needs to be treated too along with DTs. Treatment includes giving two pairs of Pabrinex ampoules. This medicine is given with the use of IV three times a day for three succeeding days. If a patient does not show signs of getting well with this treatment, then it should be stopped. If the signs of DTs alleviate, then give the patient Pabrinex once a day or until the improvement continues.

Magnesium should be given to the patient as it helps reduce symptoms of seizures and irregular heart rate.

Once the person recovers from Delirium tremens, preventive treatment geared for the long haul should commence.

Prevention steps may include:

  • Follow up on the patient regularly
  • Inpatient care or outpatient care may be recommended, depending on the status of health of the patient
  • The patient’s GP may need to be involved with the follow up preventive treatment
  • A “drying out” time, wherein the patient will not consume alcohol
  • Total abstinence from alcohol
  • The doctor will prescribe drugs that may be used to prevent alcohol relapse
  • The patient needs psychological counseling specifically addressing any existing psychological problems, such as other forms of addiction
  • Joining support groups whether online or offline can help boost the person’s resolve to stay away from alcohol such as Alcoholics Anonymous, Smart Recovery, American Addiction Centers
  • and Rehabs.com

The individual may also require further treatment of disorders brought about by long-term use of alcohol, which includes the following:

Alcoholic cardiomyopathy

Alcohol addiction may cause heart failure. The patient may be prescribed with ACE inhibitors. A change in diet to reduce sodium intake is needed. If the medications do not work, a heart transplant might be necessary.

Alcoholic liver disease

Heavy consumption of alcohol can cause problems in the liver, such as scarring and liver cirrhosis. The patient may need to take antibiotics and undergo fluid removal from the abdomen. Liver cancer may result if this problem is left untreated.

Alcoholic neuropathy

This is when nerve damage occurs due to heavy drinking. The patient may feel numbness, muscle issues and pain. Physical therapy and medications to stop the pain may be needed. Nerve damage is incurable.

Wernicke-Korsakoff syndrome

This is brain damage due to alcoholism. The affected areas are the hypothalamus and the thalamus – the brain areas responsible for memory. Vitamin B1 can alleviate muscle issues, but memory loss is incurable.

Prevention of Delirium Tremens

The best prevention is to abstain from alcohol.

If you do, drink moderately. If you have been drinking for some time, then slowly reduce the consumption of alcohol. It is important to seek medical help if attempting to quit alcohol use, especially to those who develop alcohol addiction.

Due to the extreme nature of Delirium tremens, those who are at risk of experiencing DTs should be identified before the symptoms manifest. One particular helpful prevention tool is the diagnostic assessment tools that are used to qualify the individual’s risk for developing DTs. These tools are provided by medical personnel. It does not only identify the people at risk for DTs, but it also provides the most suitable treatment plan for the individual.

People who are determined to be prone to DTs often need in-patient detoxification procedures under constant medical supervision. The person may sometimes be put in the intensive care unit until the risks are gone.

Early detection of the symptoms is also essential. This is crucial to prevent a fatality. Quick action and prompt treatment for this extreme form of alcohol withdrawal symptoms can decrease risks of mortality.

Delirium tremens can be fatal and should be treated right away.

If left untreated, the mortality rate can go up to 35 per cent. But early detection can lower mortality rate to 2 per cent. When a person shows symptoms of DTs, get medical help right away.