Have you ever heard that some people who are heavily addicted to alcohol suddenly stop drinking have a very bad time? Sometimes they lose consciousness, their whole body starts shaking, and they become unimaginably dangerous. So, the most severe and dangerous condition that can occur when you give up alcohol is the one we are going to talk about today , Delirium Tremens , or DTs for short. This can sometimes be life-threatening.
What is Delirium Tremens? Why does it happen?
Simply put, Delirium Tremens is a very serious condition that can occur when someone who is severely addicted to alcohol (especially someone with moderate or severe alcohol use disorder ) suddenly stops drinking alcohol completely.
Now let's see how this works. When someone drinks too much alcohol over a long period of time, their body goes into a strange struggle. Think of it like a tug-of-war. On the one hand, alcohol is a depressant of our central nervous system (CNS) , like the brakes on a car. This central nervous system controls our breathing and heart rate. When alcohol depresses this function (that is, acts as a depressant ), on the other hand, our central nervous system counteracts this by increasing its activity, trying to keep the body functioning properly. Over time, our central nervous system becomes accustomed to this increased level of activity, and thinks that this is its "normal" level.
So, when you suddenly stop drinking alcohol, it's like you've let go of one end of the rope. The central nervous system doesn't have to increase its activity to counteract the effects of alcohol. But it can't decrease its activity all at once either. That means the central nervous system becomes much more active than it should be. That overactivity is what causes even the body's natural processes to become disrupted, and this condition called delirium tremens occurs. Do you understand?
How common is this condition?
In fact, alcohol use disorders are more common than you might think. For example, it is estimated that about 29% of American adults will experience this condition at some point in their lives. However, only a very small percentage of them, between 1% and 1.5%, develop delirium tremens (DTs). However, even for that small percentage, it can be very dangerous.
What are the symptoms of Delirium Tremens?
Delirium tremens (DTs) can have many symptoms. Some are familiar to us, while others are less well-known. Let's look at some of the main symptoms:
- Tremors or shakes: This is a symptom that most people are familiar with and commonly see. The hands in particular tend to shake a lot.
- Confusion: This is a mental disorder that is specific to alcohol withdrawal. Doctors sometimes call it ``altered mental status.'' The "delirium" part of the name "delirium tremens" comes from this mental disorder and the "tremor" part is the shaking.
- Agitation or anxiety: This can cause the patient to behave in a violent and aggressive manner.
- Psychosis symptoms: People with delirium tremens (DTs) may experience hallucinations , which are seeing, feeling, or hearing things that are not there. They may also experience other psychotic symptoms, such as paranoia.
- Sensory disruptions and disorientation: People with delirium tremens (DTs) have a reduced awareness of their surroundings because their senses are not working properly.
- Bouts of heavy sweating (diaphoresis): People with delirium tremens (DTs) experience occasional bouts of profuse sweating, not continuous.
- Seizures: Often, alcohol withdrawal symptoms can be preceded by seizures, which can progress to delirium tremens (DTs). These seizures can be life-threatening if they progress to a dangerous condition called status epilepticus .
- High body temperature (hyperthermia).
- Headaches.
- Nausea and vomiting.
- Increased heart rate (fast heart rate - tachycardia).
Importantly, one or more of these symptoms may begin to appear within one to three days of stopping alcohol, with the most severe symptoms occurring after four to five days.
What causes Delirium Tremens?
The only cause of delirium tremens (DTs) is the exacerbation of withdrawal symptoms caused by a person with an alcohol use disorder suddenly stopping drinking alcohol.
What are the risk factors for Delirium Tremens?
Some factors may increase the risk of developing delirium tremens (DTs). These include:
- If you have previously experienced alcohol withdrawal symptoms, seizures, or delirium tremens (DTs).
- If you have stopped drinking heavily and started again several times.
- Excessive alcohol consumption (the more you drink, the greater the risk).
- If you are addicted to other drugs (especially sedatives or hypnotics ) at the same time. These substances also reduce the activity of the central nervous system.
- Increasing age. The risk of developing delirium tremens (DTs) increases with age. People under 30 years of age are less likely to experience alcohol withdrawal symptoms and delirium tremens (DTs).
- Other health problems. For example, conditions like nutritional deficiencies, heart disease, and liver disease.
What are the possible complications of Delirium Tremens?
Both Alcohol Use Disorder and Delirium Tremens (DTs) can cause a number of serious complications. Some of them are:
- Nutritional deficiencies, especially Wernicke-Korsakoff syndrome (vitamin B1 deficiency caused by alcoholism).
- Seizures.
- Anxiety and depression.
- Sleep problems (Sleep disruptions).
- Heart and circulatory problems.
How is Delirium Tremens diagnosed?
Typically, an emergency room physician or other clinician can diagnose delirium tremens (DTs) by combining several methods and tools. These include:
- Physical examination.
- Neurological examination.
- Specific checklists that provide scores indicating the likelihood of developing delirium tremens (DTs) based on symptoms. An example is the CIWA-Ar (Clinical Institute for Withdrawal Assessment for Alcohol Revised Scale) .
- Laboratory testing.
What are the diagnostic tests?
Many of the tests that help diagnose delirium tremens (DTs) are done in a laboratory. They require blood or urine samples. These tests look for:
- The function of your internal organs, especially your liver, kidneys, and heart.
- Blood alcohol level.
- Urine drug test.
- Electrolyte levels.
Depending on your symptoms or if you have other health problems, you may need to have more tests. Your doctor can tell you more about the tests they recommend.
How is Delirium Tremens treated? Can it be cured?
Delirium tremens (DTs) cannot be completely "cured", but it can be very well treated . One of the main features of delirium tremens (DTs) is memory loss. As a result, people with this condition cannot make informed decisions about their treatment. If you are unable to make decisions for yourself, your family or loved ones may have to make those decisions for you.
The main goal of treating this condition is to reduce the overactivity of the nervous system. A doctor treats this by using drugs that reduce the activity of the central nervous system (CNS). There are several types of drugs for this.
Treatment for delirium tremens (DTs) usually begins with sedatives . These help to reduce the activity of the central nervous system (CNS). This excessive nervous activity is the cause of many of the most dangerous problems in delirium tremens (DTs). The most commonly used sedatives are a class of drugs called benzodiazepines . However, other types of drugs may also be used. Very rarely, people with extremely high central nervous system (CNS) activity may need to be completely sedated and given general anesthesia to prevent the most dangerous symptoms of delirium tremens (DTs).
Many people with delirium tremens (DTs) also have dehydration , electrolyte imbalances, or mineral deficiencies. Your doctor can treat these conditions by giving you a saline solution ( IV ) that contains vitamins and minerals. Some saline solutions are specially formulated for these conditions. For example, a saline solution that is affectionately known among doctors as " banana bag" (so-called because of the yellow color of the solution). It contains vitamin B1 ( thiamine ), vitamin B9 ( folate ), a multivitamin, an electrolyte solution, and more.
Treating Alcohol Use Disorder
The main cause of delirium tremens (DTs) is alcohol use disorder. After treating delirium tremens (DTs), the long-term goal is to treat the alcohol use disorder. There are many treatments for this. Treatment for this can reduce the risk of delirium tremens (DTs) in the future.
What are the complications or side effects of the treatment?
Complications of delirium tremens (DTs) treatment depend largely on the treatment you receive. Because there are many different medications and treatments, side effects can vary greatly. Your doctor can best explain the complications you may experience after your symptoms improve and your dementia is gone. Or, your doctor will share these details with loved ones who have been given permission to know your medical information and make decisions for you.
How quickly will I feel better after treatment?
The main symptoms of delirium tremens (DTs) usually take about three to seven days to resolve. During that time, you will gradually begin to feel better. In severe cases, some symptoms may persist for weeks or even months.
What should I expect if I have Delirium Tremens?
If you have delirium tremens, one of the main symptoms you will experience is confusion. You will have difficulty understanding what is happening to you and what is happening around you. You may also experience hallucinations. This means that things that you see or hear are real may not actually be there.
Because of these symptoms, you may not be able to make decisions about your medical care. Doctors will treat you to stabilize you (unless you have filed an advance medical directive with them). They may also talk to your family, friends, or other close people you have given permission to know about your medical care and make decisions.
How long does Delirium Tremens last?
Delirium tremens (DTs) usually lasts about seven days, although some people may have symptoms for up to two weeks.
What is the outlook for Delirium Tremens?
The outlook for delirium tremens depends on several factors. These include:
- Severity of symptoms.
- The severity of your alcohol use disorder.
- Other medical conditions you have.
- How quickly you received medical attention.
Even with treatment, one of the complications of delirium tremens (DTs) is death. If left untreated, about 15% of people with delirium tremens (DTs) die. The risk of death is even higher if you have other serious medical conditions. With treatment, the survival rate for delirium tremens (DTs) is about 95%. The sooner someone receives treatment for delirium tremens (DTs), the better their chances of survival and a good outcome.
Can Delirium Tremens be prevented?
The only sure way to prevent delirium tremens (DTs) is to completely abstain from alcohol.
If you have an alcohol use disorder and want to stop drinking, talk to a doctor. They can help you find resources, care, and support to help you safely reduce your alcohol use. They can also recommend alcohol rehabilitation programs, specialist doctors, support groups, and more.
The best way to prevent or reduce the risk of developing Alcohol Use Disorder (and therefore DTs) is to drink in moderation. That means drinking according to the following guidelines:
- For men: The recommended number of alcoholic drinks per day should be no more than two, and no more than 14 per week.
- For women: The recommended number of alcohol units per day should be no more than one, and no more than seven per week.
Alcohol use disorder is not caused by just one cause. Family history, mental health conditions, and many other factors can contribute to it. If you are concerned about your risk of developing alcohol use disorder, it is a good idea to talk to a doctor. They can help you understand your risks and give you advice on what to do about them.
What is "one drink"?
"One drink" is the equivalent of 14 grams (14 g.) of pure alcohol. Because some types of alcohol have a higher alcohol concentration, "one drink" can come in many forms.
Each of the following examples is equivalent to "one drink":
- 12 ounces of regular beer (about 355 ml)
- 8-10 ounces (about 237-296 ml) malt liqueur
- 5 ounces of wine (about 148 ml)
- What we call a "shot" is 1.5 ounces (about 44 ml) of spirits (e.g. gin, rum, whiskey, vodka) (which is 40% alcohol by volume).
How much does it take to develop Delirium Tremens?
Anyone who meets the criteria for heavy drinking can develop delirium tremens (DTs). For men, this means drinking three or more drinks per day and 15 or more drinks per week. For women, this means drinking two or more drinks per day and eight or more drinks per week. However, the more you drink and the more you continue to drink, the more likely you are to develop delirium tremens (DTs).
It's hard to give a specific number that works for everyone because everyone is different. Some people have a higher tolerance for alcohol. Some people are more likely to get drunk on alcohol due to genetic factors. Others may be more likely to get drunk and suffer from delirium tremens (DTs) due to medications they take, health conditions, and other factors.
Because delirium tremens (DTs) can occur in people who drink alcohol at varying levels, the best way to prevent delirium tremens (DTs) is to drink in moderation or not drink at all.
Finally, what to remember (Take-Home Message)
Delirium Tremens is a serious, even life-threatening condition that can occur when someone with alcohol use disorder suddenly stops drinking alcohol. If you have alcohol use disorder, cutting down or completely stopping drinking is an important step you can take to improve your health. But it's a goal you need to approach safely, and you don't have to do it alone.
If you have an alcohol use disorder and want to cut down or stop drinking altogether, a primary care provider can help you find resources and rehabilitation programs that can help. Many people are embarrassed or afraid to ask for this kind of help. However, your doctor's job is to help you, not to judge you. That way, you can safely reduce your drinking and improve your health, well-being, and overall quality of life.
` Delirium tremens, alcohol withdrawal, alcohol side effects, alcohol withdrawal, alcohol addiction, DTs, dementia
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