Delirium tremens (often called DTs or "the DTs") is a medical emergency. It is the worst form of alcohol withdrawal, which can happen when a person who drinks a lot of alcohol suddenly stops drinking. "Delirium" means very bad confusion that comes on quickly; "tremens" means "shaking."
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An alcoholic man with delirium tremens on his deathbed, surrounded by his terrified family.
Who gets DTs?Edit
Most people who stop drinking alcohol do not get the DTs. But some people are more likely to get the DTs if they suddenly stop drinking. DTs are more likely in people who:
- Have had seizures when they tried to stop drinking alcohol before
- Have drunk a lot of alcohol every day for several months
- Have drunk alcohol for more than 10 years
- Are sick or have other medical problems when they suddenly stop drinking
DTs cause symptoms that can be very bad and very dangerous. Even though not many people get DTs when they stop drinking, many people that do get DTs die from them. Others get permanent brain damage or other problems.
Symptoms usually start within 2 to 3 days after the person had their last drink. But in some people, DTs can happen up to a week or 10 days after their last drink.
- Very bad seizures, especially status epilepticus
- Hyperthermia (a very high body temperature; if the body's temperature gets high enough, the brain will die)
- Severe hypertension (very high blood pressure; if the blood pressure gets high enough, it can cause a stroke)
- Severe tachycardia (very high heart rate; if the heart beats too fast, it cannot get blood and oxygen to the rest of the body. Without enough blood and oxygen, no part of the body can survive. Eventually breathing can stop. The brain can die or be damaged. The heart can stop beating normally or stop beating completely.)
Other changes to the bodyEdit
Other body symptoms caused by DTs include:
- Very bad sweating
- Shaking or tremors (which may be uncontrollable)
- Insomnia (being unable to sleep)
- Feeling very restless
Changes to thinking and feelingsEdit
- Very bad anxiety, panic attacks, paranoia, or agitation (feeling very upset and unable to relax)
- The person may be so anxious or upset that they are certain they are going to die
- Being very confused (for example, the person might not recognize their family members)
- Being disoriented (for example, the person may not know who he is, where he is, or what is happening)
- Being unable to think normally or pay attention to anything
- Being unable to talk normally
Changes to the sensesEdit
- Visual hallucinations: seeing things that are not really there. These things seem very real to the person with DTs. For example, sometimes people with DTs see very scary visions of insects, snakes, or rats.
- These visions often go along with the feeling that things like bugs are crawling on the person with DTs.
- Auditory hallucinations: hearing things that are not really there.
- Benzodiazepines are the most common type of medicine used for DTs. In the United Kingdom, chlordiazepoxide (Librium) and diazepam (Valium) are most often used. In the United States, lorazepam (Ativan) and oxazepam are often used too. These medicines will keep the person asleep or relaxed, make them more comfortable, and help prevent seizures.
- Sometimes anticonvulsant (anti-seizure) medicines are also used to prevent or treat seizures.
- Antipsychotic medicines, like haloperidol (Haldol), may be used to help make hallucinations go away.
People with DTs are also often given thiamine (vitamin B1), an important vitamin, because alcoholics often do not have enough thiamine. If thiamine levels are low enough, this can cause brain damage.
- Burns, MD, FACEP, FACP, Michael James (April 14, 2015). "Delirium Tremens (DTs)". medscape.com. Medscape. Retrieved December 27, 2015.CS1 maint: multiple names: authors list (link)
- National Institute for Health and Care Excellence (2010). Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications - NICE Clinical Guidelines, No. 100 (Report). Royal College of Physicians. Retrieved December 27, 2015.
- Michael Burns; James Price & Michael E Lekawa (2008). "Delirium Tremens: eMedicine Critical Care". emedicine.medscape.com. Retrieved 2009-06-23.
- Gossman, William (2007). "Delirium Tremens: eMedicine Emergency Medicine". emedicine.medscape.com. Retrieved 2009-06-23.
- Martin, MD, MPH, ABIM, Laura J. (February 8, 2015). "Delirium Tremens". nlm.nih.gov. U.S. National Library of Medicine. Retrieved December 27, 2015.CS1 maint: multiple names: authors list (link)