The initial phase is characterized by patient agitation and non-collaboration. This phase should be aggressively treated, in order to reduce the risk of medical complications (seizures, DTs, death), reduce patient suffering and improve quality of life. The direct effect of these measures will be, in most of cases, a strong physician-patient relationship. The latter is necessary to improve patient’s disposition toward medical management and to start a long-term, multidisciplinary treatment of alcohol dependence. 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.
- According to a study, delirium tremens is estimated to affect between 5% and 12% of people who are dependent on alcohol.
- The symptoms of withdrawal are not specific and easily can be confused with other medical conditions.
- You are more likely to have DTs if you have moderate or severe alcohol use disorder (heavy or frequent alcohol use even if it causes physical or emotional harm).
- Even less often, people see, feel, smell, or even taste things that aren’t real.
Acute alcohol ingestion produces CNS depression secondary to an enhanced GABAergic neurotransmission 9 and to a reduced glutamatergic activity. The stimulation of GABAA receptors 10 and the inhibition of N-methyl-D-aspartate (NMDA) receptors 10, 11 represents the most known mechanisms. However, the guidelines also state that people who do not currently drink are not encouraged to begin drinking alcohol. English author George Eliot provides a case involving delirium tremens in her novel Middlemarch (1871–72). Alcoholic scoundrel John Raffles, both an abusive stepfather of Joshua Riggs and blackmailing nemesis of financier Nicholas Bulstrode, dies, whose “death was due to delirium tremens” while at Peter Featherstone’s Stone Court property.
Other medical co-morbidities which need special mention here are hepatic and cardiac diseases. Liver disease is more often present than absent in the setting of chronic heavy use of alcohol. Hepatic encephalopathy (HE) is a close differential diagnosis of DT, given the presence of altered sensorium and tremor. However, delirium in HE is usually hypoactive i.e., patients are mostly drowsy and retarded (as opposed to aroused and agitated in DT) and tremors are only visible at hands (flapping tremors) in a particular position (as opposed to whole body tremor in DT). Nevertheless, it must be borne in mind that DT and HE might co-exist and complicate the clinical presentation and management.65 Moreover, HE can be broadly classified as covert and overt HE.
Management of Alcohol Withdrawal
Almost 25% of AWS patients show transient alterations of perception 27, 28 such as auditory (voices), or, less frequently, visual (zooscopies) or tactile disturbances 26. They may be persecutory and cause paranoia, leading to increased patient agitation 27. When these symptoms become persistent, the patient Effect of Motivational Enhancement Therapy MET on the self efficacy of Individuals of Alcohol dependence PMC has progressed to alcoholic hallucinosis. However, the patient recognizes the hallucinations as unreal, as dysperceptions, and maintains a clear sensorium 26.
6 Other Drugs
Physical examination and laboratory testing should be curtailed to identify underlying medical problems and identifying potential electrolyte abnormalities, renal and liver function, sources of infection, coronary ischemia, rhabdomyolysis, and other drug use. People with alcohol use disorder who suddenly stop drinking may also have a spike in an amino acid called glutamate. Glutamate causes some common delirium tremens symptoms, such as a sudden, extreme spike in blood pressure, tremors, severe excitability, and seizures. You are more likely to have DTs if you have moderate or severe alcohol use disorder (heavy or frequent alcohol use even if it causes physical or emotional harm). Nearly one-third of U.S. adults will have alcohol use disorder at some point in their lives, and it is estimated that about 1% of those people may get delirium tremens.
What Medications Are Used to Treat Delirium Tremens?
Withdrawal seizures can occur in patients within just a few hours of alcohol cessation. About half of the patients with alcohol use disorders develop withdrawal syndrome and only a minority of them would require medical attention.6 A further smaller subset would develop severe alcohol withdrawal syndrome with DT. Therefore, DT is not very common, even in people with alcohol dependence. Clinicians need to evaluate the severity of alcohol withdrawal based on history and clinical presentation. The best-validated tool to assess the severity of alcohol withdrawal is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar).
Withdrawal from alcohol is an uncomfortable process and can be dangerousor even deadly. One of the dangerous complications of alcohol withdrawal is a condition known as delirium tremens, or DT, which can be life-threatening. Moreover, the oral route administration 96, 97 gave the possibility of an outpatient treatment regimen, resulting in a significant reduction in the cost of treatment compared to inpatient AWS treatment.
Symptoms of DT may start to show up as early as 48 hours after the last drink and generally occur within the first 72 hours. However, in some cases, DT symptoms may take as long as 10 days to show up. Research suggests that if you have had DT before, then you may be more likely to get symptoms of DT earlier during withdrawal. Also, you may get other symptoms of AWS such as nausea and vomiting earlier during withdrawal and later may progress to a more serious form of withdrawal like DT. Delirium tremens, or DT, is a serious form of alcohol withdrawal syndrome.
It is a 10-item questionnaire tool to evaluate, monitor, and treat alcohol withdrawal. It includes symptoms of withdrawal such as anxiety, nausea, and sweating, among others. A score of 8 points or lower corresponds to mild withdrawal, while a score of 9 to 15 corresponds to moderate withdrawal, and a score of 15 or greater corresponds to severe withdrawal symptoms, being at risk for seizures and DT. 910 CIWA-Ar is not recommended for withdrawal delirium due to its subjective nature and patients’ inability to accurately report withdrawal symptoms. Despite this current understanding of the mechanisms underlying AW syndrome, some controversies still exist regarding the risk, complications, and clinical management of withdrawal. These controversies likely arise from the varied clinical manifestations of the syndrome in alcoholic patients and from the diverse settings in which these patients are encountered.