Delirium Tremens and Alcohol Withdrawal

Delirium tremens (DTs) occurs in chronic alcoholics who are withdrawing from alcohol. Alcohol withdrawal causes a spectrum or clinical manifestations from mild tremulousness to seizures, hallucinations (may be auditory or visual and are often dramatic, e.g., bugs crawling on patient, or persecutory), and delirium. Aggressive treatment with benzodiazepines is required when early symptoms and signs are present to prevent progression of alcohol withdrawal syndrome. DTs can lead to death.

Causes

Delirium tremens can occur after a period of heavy alcohol drinking, especially when the person does not eat enough food.

It may be triggered by head injury, infection. It is manly common in people who have a history of experiencing alcohol withdrawal when alcohol is stopped, especially in those who drink the equivalent of 7 - 8 pints of beer per day for several months, and in those with a history of habitual alcohol use or alcoholism that has existed for more than 10 years.

Symptoms occur because of the toxic effects of alcohol on the brain and nervous system. They may be severe and progress rapidly.

Symptoms

Depend on stage of withdrawal

• Early: Shaking, anxious, nausea, vomiting
• Late: Seizures, altered mental status

Signs

Depend on stage of withdrawal

• Early: tremor, increasing levels of autonomic activity as condition progresses (tachycardia, hypertension, hyperreflexia)
• Late: diaphoresis, seizures, hallucinations, delirium

Treatment

Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with benzodiazepines, such as diazepam and it is also known as Valium, lorazepam and in extreme cases low-levels of antipsychotics, such as haloperidol until symptoms subside. If status epilepticus is present, seizures are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimise visual misinterpretations such as the visual hallucinations mentioned above.