What is delirium tremens?
Delirium, also known as toxic confusional state or complicated alcohol abstinence , is a mental disturbance resulting from brain disorder. It features confusion of thought, disorientation, restlessness and other symptoms.
Delirium tremens, sometimes referred to as ‘the DTs’, has special features of its own. It affects people on alcohol withdrawal after a long period of heavy drinking.
Delirium tremens can be fatal and requires urgent medical help in hospital.
Symptoms of delirium
Over a period of two or three days after drinking has stopped, there is irritability, restlessness, lack of concentration and insomnia or disturbed sleep with nightmares. In about a quarter of cases there is then a major epileptic fit (seizure).
The affected person begins to show signs of distress and perplexity. There are:
- purposeless body movements,
- tremor (hence the name),
- constant and sometimes incoherent talk,
- indications of severe annoyance and a sense of threat.
Ordinary conversation is misinterpreted in a paranoid manner and there are vivid hallucinations, usually very unpleasant ones.
The affected person may see terrifying sights (visual hallucinations), smell horrifying smells (olfactory hallucinations), feel all sorts of distressing touchings (tactile hallucinations) or hear threatening or frightening sounds, including language (auditory hallucinations).
At first, there are intervals of contact with reality, but this soon passes and the stage is reached at which the hallucinations are continuous and the person becomes inaccessible to questioning and profoundly disoriented. After two or three days all these symptoms begin to settle, and recovery is often sudden.
Causes of delirium
When a person has become thoroughly adapted to very high levels of alcohol, a sudden drop in the alcohol level in their blood may cause severe disturbance of brain function and nervous system. This may be accompanied by high pulse rate, high blood pressure, and high temperature.
Delirium tremens may also be triggered by infection, illness, or head injury in people with a history of alcohol abuse.
Delirium tremens treatment
Fluids are given if the person is dehydrated. Acute delirium is controlled with sedative drugs such as the benzodiazepines. The drug haloperidol is commonly used in severe delirium.
Once the delirium has passed, the person’s nutritional state is checked and deficiencies, especially in the B vitamins, are corrected. Calories are provided from a non-alcohol source.
Alcohol intake is either cut altogether or reduced to a very moderate level. A full investigation into the person’s state of general health, including liver function tests, is then required.
Complications of delirium
In about 10% of cases, the attack of delirium tremens is associated with such severe physical disorder, such as circulatory collapse, exceptionally high fever (hyperthermia), head injury, liver failure, pneumonia or metabolic upset, that it ends in death.
How to prevent delirium?
Delirium tremens is a serious warning of heavy alcohol abuse. It can be prevented by cutting down alcohol intake or giving it up completely. This is unlikely to be achieved without expert professional help.