Delirium tremens (DTs) is a potentially fatal side effect of alcohol withdrawal. Anyone with a risk of experiencing DTs should only detox under medical supervision.
Delirium tremens1 (DTs) is a life-threatening condition that can accompany alcohol withdrawal. While many people experiencing alcohol withdrawal symptoms will not develop this condition, those who do will have a very high risk of serious complications or death. People with DTs should seek immediate medical attention, as the risk of death is many times higher when the condition is left untreated.
What Is Delirium Tremens?
Delirium tremens is a severe form of alcohol withdrawal that normally begins 48 to 72 hours after someone’s last drink. This condition is characterized by a confused delirium, hallucinations and seizures.
Delirium tremens is a medical emergency that requires professional medical attention. This condition is fatal for 37% of people2 when it is not treated medically, and it is also fatal for 5% of those3 who do seek medical care. Fatalities are often due to respiratory or heart rhythm complications.
How Much Do You Have To Drink To Get DTs?
Delirium tremens is not predictable, but it generally occurs in those who have used alcohol heavily. The condition is most common4 in people who drink certain amounts of alcohol each day for several months:
- Four to five pints of wine
- Seven to eight pints of beer
- One pint of liquor
The condition is also common in people who have been drinking for more than 10 years. However, someone who has used alcohol for less than 10 years or has not used it very heavily can still develop delirium tremens.
Delirium Tremens Symptoms
Delirium tremens is diagnosed7 when delirium occurs alongside severe alcohol withdrawal symptoms. Delirium is a term used to describe confusion, changes in awareness, memory problems or fluctuations in cognitive ability. Severe alcohol withdrawal is considered to be present when at least two of these symptoms are present:
- Hyperactive autonomic nervous system6
- Hand tremors
- Nausea or vomiting
- Uncontrollable restlessness
Delirium tremens can only be diagnosed by a doctor. Someone who is suspected of having this condition should be taken to the nearest hospital as soon as possible.
Delirium Tremens Timeline
Delirium tremens typically develops within 48 to 72 hours after stopping drinking7. However, it can start as early as 24 hours after your last drink or as late as six days after the last drink. Delirium tremens normally lasts one to six days, but in rare cases, it can last as long as 28 days8.
The timeline for delirium tremens is unpredictable for specific cases. In addition, the delirium that it causes can affect a person’s ability to perceive time normally.
What Causes Delirium Tremens?
Delirium tremens is caused by withdrawal from alcohol9. The exact mechanisms that distinguish delirium tremens from more routine alcohol withdrawal are not fully understood. However, the causes of alcohol withdrawal are well understood. Alcohol withdrawal occurs because the brain slowly reduces the sensitivity of GABA receptors10 when alcohol is used for prolonged periods of time. When alcohol use is stopped, the reduced sensitivity of these receptors causes withdrawal symptoms. These symptoms continue until the brain can readjust receptor sensitivity.
There are several risk factors that can increase the risk of developing DTs11 when stopping alcohol use. These include:
- An acute illness during alcohol withdrawal
- Daily heavy alcohol use
- A history of delirium tremens
- A history of withdrawal seizures
- Older age
- Altered liver function
- More severe initial withdrawal symptoms
While risk factors increase the likelihood of delirium tremens, the absence of these risk factors does not mean that someone is safe from DTs during alcohol withdrawal.
Delirium Tremens Is a Medical Emergency
Delirium tremens is a medical emergency, as untreated delirium tremens is deadly in over one-third of cases. Someone who has DTs will normally be unable to get help themselves and will need someone around them to recognize their need for medical assistance.
Delirium tremens can cause death due to how it can affect the ability to breathe or ability to maintain a normal and healthy heart rhythm. It can also cause other complications and injuries12, such as falls or injuries caused by seizures. Delirium tremens can also cause someone to hallucinate or enter a confused state, leading them to accidentally injure themselves or others.
Delirium Tremens Treatment
If someone is experiencing delirium tremens symptoms, they should immediately seek emergency medical care. If someone is about to quit alcohol and begin withdrawal, they should first talk with their doctor about their risk of developing delirium tremens. This will help them to prepare for the possibility of DTs before symptoms occur and help them avoid this potential complication.
Delirium Tremens Medication
The main medications used to treat delirium tremens are benzodiazepines13. These medications act on the brain in a way similar to alcohol, which allows it to treat some of the neurological effects of alcohol withdrawal. These medications may be given as tablets; for those suffering from DTs, however, they should ideally be given by IV in a hospital.
Alcohol detox is the process of allowing the body to adjust to the absence of alcohol. Someone who may experience delirium tremens should always detox under medical supervision. A medically supervised alcohol detox will:
Inpatient and Outpatient Alcohol Rehab
For people withdrawing from alcohol, rehab is the next step after detox. Rehab helps those recovering from addiction to learn and practice strategies to stay sober throughout the future. Rehab can take place in an outpatient or inpatient setting. Outpatient rehab involves attending appointments during the day, while inpatient rehab involves staying in a treatment facility during the course of rehab. Inpatient rehab allows for more intensive treatment in a healing environment.
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- Toohey, Shannon. “Delirium Tremens (DTs).” Medscape, August 4, 2021. Accessed February 2, 2022.
- Rahman, Abdul; Paul, Manju. “Delirium Tremens.” StatPearls, August 27, 2021. Accessed February 2, 2022.
- Burns, Michael James. “What is the mortality rate for delirium tremens (DTs)?” Medscape, November 6, 2020. Accessed February 2, 2022.
- U.S. National Library of Medicine. “Delirium tremens.” MedlinePlus, February 4, 2022. Accessed February 2, 2022.
- Paul, Manju; Rahman, Abdul. “Delirium Tremens.” National Library of Medicine, August 27, 2021. Accessed October 7, 2022.
- Benarroch, Eduardo E. “Autonomic Hyperactivity.” Autonomic Neurology, May 2014. Accessed February 2, 2022.
- Grover, Sandeep; Ghosh, Abhishek. “Delirium Tremens: Assessment and Management.” Journal of Clinical and Experimental Hepatology, December 2018. Accessed February 2, 2022.
- Kafle, Paritosh; Mandal, Amrendra Kumar; et al. “Twenty-Eight-Day-Long Delirium Tremens.” Journal of Investigative Medicine High Impact Case Reports, May 3, 2019. Accessed February 2, 2022.
- Saitz, Richard. “Introduction to Alcohol Withdrawal.” Alcohol Health and Research World, 1998. Accessed February 2, 2022.
- Davies, Martin. “The role of GABA receptors in mediating […]ntral nervous system.” Journal of Psychiatry & Neuroscience, July 2003. Accessed February 2, 2022.
- Bayard, Max; Mcintyre, Jonah; et al. “Alcohol Withdrawal Syndrome.” American Family Physician, March 2004. Accessed February 2, 2022.
- Trevisan, Louis A.; Boutros, Nashaat; et al. “Complications of Alcohol Withdrawal.” Alcohol Health and Research World, 1998. Accessed February 2, 2022.
- Toohey, Shannon MD. “Delirium Tremens (DTs) Medication.” Medscape, August 4, 2021. Accessed October 25, 2022.
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