Delirium Tremens: When Does Alcohol Cause DTs?

Heidi Moawad, MD
·7 min read

A serious consequence of alcohol withdrawal

Medically reviewed by Nicholas R. Metrus, MD

Delirium tremens is a serious condition that develops due to alcohol withdrawal. People who consume large amounts of alcohol for an extended period can be susceptible to this withdrawal effect. Delirium tremens can be fatal if it is not treated promptly.

This article describes the symptoms and treatment of delirium tremens and guidelines regarding your risk and what you can do to avoid it.

<p>Motortion / Getty Images</p>

Motortion / Getty Images

Emergency Delirium Tremens Symptoms

Symptoms of delirium tremens worsen very quickly and can cause death or life-altering health problems if it’s not treated immediately. If you or someone else experiences any symptoms that could be associated with alcohol withdrawal or delirium tremens, it’s important to call for emergency medical care.

Psychological

Psychological symptoms can include:

  • Feelings of anxiety

  • Agitation

  • Emotional instability

  • Confusion

  • Hallucinations

Physical

Physical symptoms can include:

  • Nausea, vomiting

  • Shaking

  • Tremors

  • Sweating

  • Racing heart

  • Dizziness

  • Shortness of breath or rapid breathing

  • Seizures

  • Loss of consciousness

Delirium tremens can cause any combination of these symptoms. If you drink large amounts of alcohol every day or almost every day, withdrawal symptoms can begin a few days after you stop drinking.

Learn More: Alcohol Use Disorder: How to Get Treatment

Alcohol Quantity and Frequency of Consumption

Generally, delirium tremens is associated with stopping alcohol after a prolonged period of using high amounts of alcohol.

According to the National Institute of Health, there’s a high risk if you consume the equivalent of the following daily for a few months or longer:

  • 4 to 5 pints (1.8 to 2.4 liters) of wine

  • 7 to 8 pints (3.3 to 3.8 liters) of beer

  • 1 pint (1/2 liter) of "hard" alcohol

While these amounts are associated with a high risk of delirium tremens, the risk could vary based on age, weight, liver function, health issues, and medication or drug use.

If you drink several alcoholic beverages per day and you are thinking about quitting, you need to discuss the process of quitting with a healthcare provider. You can work together to create a safe schedule for you to gradually discontinue alcohol under medical supervision.



Safely Reducing Alcohol

If you consume alcohol, you should find out whether the amount that you are drinking is harmful to your health. It is beneficial for you to quit if you are consuming an unhealthy amount of alcohol or if your alcohol use is causing emotional, psychological, or relationship problems.

While quitting abruptly can be dangerous, you can safely discontinue alcohol with the guidance of a healthcare provider. The risk of delirium tremens is not a reason to continue drinking harmful amounts of alcohol.



Identifying Delirium Tremens Signs in Others

You can learn to recognize the signs of delirium tremens, but since disorientation is a key feature of the condition, most people cannot recognize their own symptoms. Generally, delirium tremens will begin about 24 hours to three days after discontinuing alcohol use—but it may begin as late as 10 days after using alcohol.

The most prominent effects of this condition are delirium (extreme confusion and disorientation) and tremors (rhythmic shaking of one or more parts of the body). In addition to these symptoms, delirium tremens can also have other effects.

Symptoms may include:

  • Shaking

  • Tremors

  • Difficulties with walking or coordination

  • Confusion

  • Disorientation

  • Excessive sweating

  • Rapid pulse

  • Rapid breathing

  • Slow breathing

  • Dizziness. lightheadedness, or fainting

Any combination of these signs can be indicative of delirium tremens.

While delirium tremens is specifically caused by alcohol withdrawal, anyone who is having these signs and symptoms is experiencing a dangerous medical emergency—even if delirium tremens do not cause the symptoms.



Prevalence

According to a study, delirium tremens is estimated to affect between 5% and 12% of people who are dependent on alcohol.



Hospitalization for Delirium Tremens

If you have signs of delirium tremens, you will need medical care in an acute care hospital setting. This may involve management in the hospital’s intensive care unit. Monitoring and treatment are directed by specific effects you are experiencing and will likely be adjusted as your condition fluctuates.

Delirium tremens is treated with sedative medications.

Treatments used for delirium tremens include:

  • Benzodiazepines, such as Valium (diazepam), Librium (chlordiazepoxide), Versed (midazolam), or Ativan (lorazepam)

  • Neurontin (gabapentin)

  • Ozobax (baclofen)

  • Phenobarbital

These treatments can help counteract the physiological process of alcohol withdrawal and will alleviate some of the symptoms. You might receive treatment on a schedule, or the timing and dose might be adjusted based on your signs and symptoms.

In addition to the management of alcohol withdrawal, you may also need treatment for specific effects of delirium tremens.

Treatments may include:

You might also need treatment for associated complications, such as treatment for a fracture or a laceration that you may have experienced during the episode.



Hospitalization Duration

The duration of hospitalization and treatment for delirium tremens ranges from approximately four to eight days, but it might last longer.



Emergency Delirium Tremens Treatment

Your initial treatment will be focused on life-saving measures to prevent the potentially fatal outcomes of delirium tremors that can occur due to brain damage or impaired breathing.

Life-saving treatments that you may receive while in the ambulance or emergency room may include:

  • Intravenous fluids

  • Blood pressure medication to raise or lower your blood pressure as needed

  • Intubation (placement of a tube in your throat to help you breathe)

  • Intravenous anti-epilepsy medication, if you are having seizures

After you are stabilized, you will need medical attention and surveillance, and your treatments can be adjusted based on your symptoms and vital signs.

Monitoring During Delirium Tremens Treatment

During your care, you will need to be monitored, which can include surveillance of vital signs and blood tests.

Monitoring may involve:

Sometimes, an electroencephalogram (EEG) might be needed to assess brain function if a person is unresponsive.



Where to Get Help

If you think you or someone you care about might have a problem with alcohol use, there are resources you can use to get help:



Relapse in Delirium Tremens

People who experience delirium tremens have a mortality rate of 8% per year. Alcohol use disorder is a serious condition.

People who have a dependence on alcohol can have a very difficult time with the process of discontinuing alcohol use. Even after a phase of decreased or discontinued alcohol use, many people who have this disorder can relapse and start drinking again.

You may be able to prevent relapse by getting treatment for alcohol use disorder. You can learn techniques, take medication, and get support and professional direction as you try to manage this condition.

Related: What Happens During Alcohol Rehab and How to Know If You Need It

Summary

Delirium tremens is a medical condition that occurs in response to alcohol withdrawal. This is a serious reaction that can be fatal. The symptoms can begin several days after abruptly decreasing or stopping after a prolonged time of consuming a high amount of alcohol.

If you or someone else experiences symptoms of delirium tremens—tremors, confusion, changes of consciousness, or shaking—then it’s important to seek medical attention right away. Medical care may include sedatives and treatments for the effects of delirium tremens. This condition can be safely treated.

The most effective way to avoid delirium tremens is to discontinue alcohol gradually, under the guidance of a medical provider. If you have an alcohol use disorder, you could be at risk of a relapse. You can avoid a relapse—which could cause delirium tremens—by getting therapy for alcohol use disorder.

Read the original article on Verywell Health.