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Delirium Tremens

  • Definition

    Delirium tremens (DTs) is a severe disturbance of the brain caused by alcohol withdrawal.
    Adult Brain
    Brain Man Face
    The sudden withdrawal or decrease of alcohol can cause severe disturbances in the brain.
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  • Causes

    DTs occur when a person who repeatedly drinks large amounts of alcohol suddenly stops or decreases the amount of alcohol consumed.
  • Risk Factors

    These factors increase your chance of developing DTs:
    • History of heavy alcohol use and abuse
    • History of DTs or other withdrawal symptoms
    • Other medical problems (in addition to alcohol use disorder
  • Symptoms

    Symptoms usually begin 3-7 days after suddenly stopping or decreasing alcohol intake. Symptoms may include:
    • Anxiety
    • Confusion and disorientation
    • Changing levels of alertness
    • Difficulty sleeping
    • Bad dreams
    • Severe agitation
    • Fever
    • Hallucinations—the perception of a thing, voice, or person that is not present, both visual and auditory
    • Delusions—a false belief that is strongly held
    • Tremors of the hands, head, or body
    • Severe sweating
    • Rapid heartbeat
    • Nausea
    • Rapid breathing
    • Seizures
    In severe cases, DTs can result in death, especially if untreated.
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis of DTs is usually based on the symptoms and signs of the disorder after stopping alcohol use.
    Your bodily fluids may be tested. This can be done with blood tests.
    Your brain activity may be tested. This can be done with an electroencephalogram (EEG).
    Images of your internal body structures can be taken with:
  • Treatment

    Treatment can be difficult. Clearing of DTs may begin in 12-24 hours, but may take up to 2-10 days. Treatment for alcohol abuse is necessary after DTs are under control.
    Talk with your doctor about the best treatment plan for you. Options may include:
    DTs may be treated with:
    • Benzodiazepines to ease anxiety, withdrawal symptoms, and cognitive problems
    • Antiseizure medications
    • Antipsychotics to manage hallucinations or other cognitive problems
    • Pain relievers, such as acetaminophen
    • Medications to control blood pressure and heart rate
    Vitamins and Fluids
    Severe, life-threatening vitamin deficiency or dehydration may accompany DTs. Treatment may include:
    Treatment for alcohol abuse may be done in a hospital setting or while living at home. It may involve individual or group therapy. Many people seek support by participating in groups such as Alcoholics Anonymous (AA).
  • Prevention

    To prevent having DTs, manage how you drink alcohol. If you do drink large amounts on a regular basis, do not suddenly decrease the amount or stop drinking on your own. Rather, get advice from your doctor on the safest way to lower your intake.

    Alcoholics Anonymous

    National Institute on Alcohol Abuse and Alcoholism


    Alcoholics Anonymous

    Canadian Centre on Substance Abuse


    Alcohol withdrawal. EBSCO DynaMed website. Available at: Updated April 9, 2015. Accessed June 11, 2015.

    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.

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