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Alcohol withdrawal can come with many severe side effects. One of them is Delirium tremens (DTs), which is characterised by abrupt changes to the nervous system, including how the brain controls the regulation of blood circulation and breathing.

DTs can potentially be lethal if left untreated with a relatively high morbidity percentage.

The percentage of drinkers diagnosed with DTs is approximately between 5% and 10% of the drinking population.

Adult white men are the demographic most likely to develop this withdrawal effect, with the percentage reaching up to 36%, but it is seen in both men and women.

Studies have shown that there is a direct correlation between how long someone has been addicted to alcohol and the severity of their withdrawal symptoms. [2]

The effect is usually the strongest two to five days after withdrawal begins. The mortality rate for DTs has been reported as high as 15% of cases that present. [3]

That number decreases to below 5% if medical treatment is sought immediately upon the progression of DTs symptoms.

Main Causes of Delirium Tremens

If a person regularly drinks over the recommended limit, then the alcohol works as a suppressant on their system, which means the body needs to produce more of certain things to keep everything functioning correctly.

Once the alcohol is purged through extreme reduction or abstaining, the nervous system finds itself making too many of certain chemicals, causing sympathetic overdrive involving symptoms like tremors, agitation, hypertension, and tachycardia known collectively as delirium tremens. [2]

It is most often seen in people who have been drinking heavily for at least ten months. In addition to being caused directly by alcohol withdrawal, it can also follow illness, injury, or infection for individuals who excessively drink. [1]

Someone at a medical detox facility or programme may find themselves suffering from delirium tremens after they are weaned off any sedatives that might have been given to them to help with the worst of the onset withdrawal symptoms.

This can cause delayed DTs and can be dangerous for anyone who does not intend to remain in a facility for the duration of their withdrawal (e.g., detox only programmes). [4]

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At Rehab 4 Addiction, we offer high-quality rehabilitation & detoxification services tailored to your individual needs.

To discover your road to recovery, call us today on 0800 140 4690.

Associated Risk Factors

Several risk factors have been found to influence whether someone suffers from DTs and to what degree. They include the following. [5] [6]

  • A history of severe withdrawal symptoms
  • Past instances of delirium tremens
  • Pervasive alcohol-related medical issues
  • Long-term alcohol addiction
  • Multiple instances of trying to get sober
  • A history of both alcohol and drug addiction
  • Older individuals who experience DTs tend to get worse symptoms
  • A history of family members who experienced DTs
  • A history of seizures
  • Acute somatic comorbidity (e.g., infections, etc.)
  • Experiencing early withdrawal symptoms may indicate a predisposition towards DTs

 

A 2002 study by the Yale University School of Medicine revealed that some characteristics that have been shown to accompany DTs include the following. [7]

  • At least one instance of medical comorbidity (e.g., pneumonia, pancreatitis, etc.)
  • Elevated blood pressure
  • Previous cases of complicated withdrawal

The Symptoms of Delirium Tremens

The most noticeable symptoms are confusion, agitation, hyperthermia, disorientation, and hallucinations. Usually, the symptoms occur a few days withdrawal begins but can occur up to a week later.

The onset of DTs shows dramatic differences in three specific areas: a confused consciousness, distorted sensory input, and body tremors.

The worst symptoms usually occur at night and are preempted by insomnia, intense feelings of fear, and anxiety. [2]

A full list of possible symptoms related to DTs includes the following. [4]

1. Behavioural Symptoms

  • Restlessness
  • Anxiety
  • Irritability
  • Disorientation
  • Confusion
  • Impulsivity

2. Psychological Symptoms

  • Delirium
  • Hallucinations
  • Insomnia

3. Physical Symptoms

  • Unusually fast heart rate
  • Body tremors
  • Dilated pupils
  • Seizures
  • Shallow or rapid breathing with no other known cause
  • Hyperthermia
  • High blood pressure
  • Fever
  • Flu-like symptoms

How Delirium Tremens is Diagnosed

DTs can generally be determined based on symptoms alone, but it can take some time to diagnose because it often features comorbidities. It can be mistaken for similar medical issues like alcoholic hepatitis, electrolyte abnormalities, or pancreatitis, which each share similar symptom clusters with DTs. [8]

You will want to seek medical assistance when the first signs manifest. Those signs are usually confusion, anxiety, and mental or physical distress.

These are then followed quite quickly with more severe symptoms like hallucinations, shakiness with no known cause, and unusual breathing or heart rate. High blood pressure is something that will indicate the presence of DTs.

An early diagnosis will decrease the likelihood of severe illness or injury resulting from DTs or one of its related complications. [2]

If you have previous instances of delirium tremens in your medical history, then immediately making your doctor aware of this will be vital because the severity of DTs tends to increase with each instance. [8]

Identification and treatment of DTs will allow for the best possible outcome.

The DSM-5 Criteria for Diagnosing Delirium Tremens (Withdrawal Delirium)

The medical Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), uses the following criteria to determine if someone is suffering from delirium tremens:

  1. Cessation or reduction of excessive and prolonged alcohol use.
  2. At least two of the following symptoms:
  3. Autonomic hyperactivity
  4. Hand tremor
  5. Insomnia
  6. Nausea or vomiting
  7. Transient hallucinations
  8. Psychomotor agitation
  9. Anxiety
  10. Generalised tonic-clonic seizures
  11. The following signs can indicate withdrawal delirium is present.
  12. Decreased attention and awareness
  13. Disturbance to memory, language, visuospatial ability, orientation, or perception
  14. No evidence of neurocognitive disorder or coma

Possible Complications

Some of the symptoms of DTs can create significant medical complications. These are incredibly dangerous, and anyone of them could independently endanger a person’s life.

Medical professionals should treat any indication of their presence. Those symptoms and complications include the following:

  • Global confusion
  • Aspiration pneumonitis
  • Respiratory failure
  • Seizures
  • Hyperthermia and Hypertension
  • Severe rhabdomyolysis

Monitoring by Medical Professionals is Necessary

While experiencing withdrawal and severe symptoms like DTs, it is vital that you have some form of professional medical supervision. DTs can quickly spiral out of control if it is not monitored carefully by someone who knows the signs of complications.

Attending a detox facility is recommended. Once you have completed withdrawal, there are still treatment steps that can be taken to help maintain sobriety and deal with the after-effects.

This can include therapy, medications, and creating a positive support structure.

Rehabilitation Facilities and Programmes

Going through withdrawal at a facility designed to accommodate any and all medical side effects will help eliminate some of the risks inherent with DTs. Being in a facility can be useful because any personal history of DTs will be listed on your records.

With that knowledge, the medical team will be able to create a treatment plan with that in mind when they do the intake exam. [2]

Some outpatient programmes might be able to accommodate DTs, but being somewhere with 24/7 access to medical care will decrease the likelihood of the more lethal symptoms being left for too long untreated.

Most rehabilitation programmes that can assist with DTs will last between one week and twenty-eight days.

Common Medications Used for Delirium Tremens

The main treatment goal for DTs is to lessen the agitation and work to decrease the likelihood of comorbidities and seizures. Symptom triggered drug regimens have been shown to give the best results.

There are several benzodiazepines used to treat anxiety and physical distress.

They are diazepam (Valium), chlordiazepoxide (Librium), and lorazepam (Ativan). Usually, these medications are delivered intravenously. [2]

Medications to Avoid

Due to the fact that there is not enough research to show what their effects would be on severe alcohol withdrawal, there are a few medications that should be avoided if possible.

They include the following. [2]

  • Antipsychotics
  • Anticonvulsants
  • Beta-adrenergic receptor blockers
  • Baclofen

Aftercare Treatment Options

Aftercare treatment and support are vital. The period after withdrawal is when most people relapse, and that can lead to more withdrawal and another round of DTs, with each becoming more detrimental than the last.

Remaining sober requires having support and various treatment options for dealing with the stressors of daily life.

After rehabilitation keeping, yourself surrounded by a healthy support structure of friends and family members will be invaluable. Family therapy is an excellent option that is often offered during inpatient treatments.

Using that resource and then continuing it after leaving the programme or facility will help create a strong foundation during long-term recovery.

The continuation of successful sobriety is essential because every time an individual goes through withdrawal, their symptoms may worsen, including those involving DTs.

This is a highly unstable, dangerous toxic reaction with a higher likelihood of fatal outcome for people who go through it multiple times.

For anyone who has received medical treatment for DTs, it is recommended that they utilise the following treatment options.

Attend a support group or self-help meetings such as AA:

  • Cognitive-behavioural therapy to find positive coping mechanisms
  • A psychiatric assessment for mental disorders like anxiety or depression to get medication that can help stabilise moods

Ready to get help?

At Rehab 4 Addiction, we offer high-quality rehabilitation & detoxification services tailored to your individual needs.

To discover your road to recovery, call us today on 0800 140 4690.

References

[1] https://medlineplus.gov/ency/article/000766.htm

[2] https://www.ncbi.nlm.nih.gov/books/NBK482134/#_article-20326_s3_

[3] https://www.sciencedirect.com/science/article/pii/B9780702033971000288

[4] https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386

[5] https://www.downstate.edu/hbnl/documents/schuckit_1995-TheHistoriesofWithdrwalConvulsionsandDeliriumTremorsinAlcoholDependentSubjects.pdf

[6] https://pubmed.ncbi.nlm.nih.gov/21920639/

[7] https://pubmed.ncbi.nlm.nih.gov/12444353/

[8] https://escholarship.org/uc/item/08b9z9th