Part UT Health San Antonio

Definition

Delirium tremens (DTs) is a severe problem with how the brain works.

Adult Brain
Brain Man Face

The sudden withdrawal or decrease of alcohol can cause severe disturbances in the brain.

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Causes

People who drink large amounts of alcohol get DTs when they stop drinking. This can also happen when the intake is lowered. These changes are done suddenly.

Risk Factors

Your chances of DTs are higher if:

  • You're a heavy drinker or have a past problem with alcohol use disorder (AUD)
  • You've had DTs or other withdrawal problems in the past
  • You have other health problems outside of AUD

Symptoms

Symptoms start within 3-7 days once drinking stops or the amount is lowered. You may have:

  • Tremors of the hands, head, or body
  • Anxiety
  • Agitation
  • Sweating
  • Fast heartbeat— tachycardia
  • Fever
  • Nausea or vomiting
  • Sleeping problems
  • Bad dreams
  • Seizures
  • Hallucinations—seeing or hearing things that aren't there

If left untreated, DTs can result in death.

Diagnosis

You will be asked about your symptoms and health history. Your answers and a physical exam may point to withdrawal. You may have:

  • Blood tests
  • EEG —to test brain activity
  • MRI scan —to check a head injury or if you had seizures
  • Lumbar puncture —to check the fluid that protects the brain and spinal cord

Treatment

The goals are to:

  • Ease symptoms
  • Avoid complications
  • Get treated for AUD

Clearing of DTs depends on how severe your problems are. It may start in 12-24 hours, but it can take up to 7 days.

Medicines

DTs may be treated with medicines used to control:

  • Anxiety, withdrawal, and problems with thinking
  • Seizures
  • Hallucinations or other mental problems
  • Pain
  • Blood pressure and heart rate

Vitamins and Fluids

Lack of vitamins and dehydration are common in more severe forms. They can be treated with IV:

Rehabilitation

AUD may be treated in a hospital or at home. It may involve single or group therapy. Many people seek support by joining groups such as Alcoholics Anonymous (AA).

Prevention

To prevent having DTs, drink in moderation. If you do drink large amounts on a regular basis, don't suddenly stop or reduce the amount on your own. Call your doctor. They will help you lower your intake safely.

RESOURCES:

Alcoholics Anonymous
https://www.aa.org

National Institute on Alcohol Abuse and Alcoholism
https://www.niaaa.nih.gov

CANADIAN RESOURCES:

Alcoholics Anonymous—Halifax Regional Municipality
http://www.aahalifax.org

Canadian Centre on Substance Use and Addiction
http://www.ccsa.ca

REFERENCES:

Alcohol withdrawal syndrome. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114807/Alcohol-withdrawal-syndrome. Updated January 17, 2017. Accessed August 21, 2018.

Alcohol withdrawal treatment, symptoms, and timeline. American Addiction Centers website. Available at: https://americanaddictioncenters.org/withdrawal-timelines-treatments/alcohol. Accessed August 21, 2018.

Barrons R, Roberts N. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. J Clin Pharm Ther. 2010;35(2):153-67.

Bayard M, McIntyre J, Hill KR, Woodside J. Alcohol withdrawal syndrome. Am Fam Physician. 2004;69(6):1443-1450.

McKeon A, Frye MA, Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psych. 2008;79(8):854-862.

Last reviewed May 2018 by EBSCO Medical Review Board Marcin Chwistek, MD  Last Updated: 8/21/2018