What Are The Symptoms Of Delirium Tremens?

Delirium tremens may sound like the words of a mystical wizard, but the reality of the Latin phrase is a much more non-fictional, life-threatening battle endured by long-term alcoholics. The Latin words, meaning “trembling delirium”, illustrate the intense symptoms experienced by the patient during their detox period.

Delirium tremens (DTs) were first named and defined in the early 1800s by physician Thomas Sutton. His research and understanding of the condition, being directly related to alcoholic beverages, led to a future of many different treatment trials and errors.

Other nicknames for delirium tremens include: “the horrors,” “the shakes,” “the bottle ache,” “quart mania,” “ork orks,” “gallon distemper,” “the zoots,” “barrel fever,” “the 750 itch,” “pint paralysis,” or “seeing pink elephants”. Delirium tremens is also referred to as alcohol withdrawal delirium in a medical reference.

How Does it Happen?

Those at risk for delirium tremens are those who drink a considerable amount of alcohol on a continuous basis. The U.S. Center for Disease Control and Prevention (CDC) defines heavy drinking as 15 drinks weekly for men and eight drinks weekly for women.

Delirium tremens are contracted by the sudden depletion of alcohol in the system after drinking heavily for a long period of time. During alcohol withdrawal, neurotransmitters in the brain no longer work properly. Therefore, seizures, tremors, and other symptoms follow an immediate cessation of alcohol use. The effects of ethanol on the gamma-aminobutyric acid (GABA) and NMDA receptors inhibit the control of norepinephrine, glutamate, and dopamine in the brain.


Alcohol remains one of several substances that, by medical advisement, is not recommended to detox from without proper medical treatment. Alcoholics who immediately stop drinking may begin to have seizures and exhibit signs of DTs in less than 48 hours. Symptoms of DTs include the following:

  • Seizures
  • High blood pressure
  • Confusion
  • Hallucinations
  • Fever
  • Tremors
  • Formication (feeling of bugs crawling on the skin)
  • Paranoia
  • High anxiety or panic attacks
  • Sleeping an entire day or longer

Alcohol Withdrawal and Delirium Tremens

Alcohol withdrawal is something that can lead to delirium tremens. However, not every individual who has these symptoms is diagnosed with delirium tremens. Symptoms differ for each patient; some exhibit signs two hours after their last drink, while others exhibit signs 48-72 hours afterward.

Six to 12 hours after the initial withdrawal, one may experience anxiety, insomnia, nausea, loss of appetite, sweating, headache and increased heart rate.

12-24 hours after withdrawal, the patient can start to experience more severe symptoms like hallucinations—both auditory and visual—as well as tactile hallucinations or formication.

48-72 hours after detoxing, the patient may experience a decrease in symptom intensity.

Delirium Tremens Deaths

Alcohol use accounts for 1 in 10 deaths among adults ages 20-64 years in the United States, according to a report from the CDC. The most common deadly results of delirium tremens include:

  • Oversedation
  • Respiratory depression, respiratory arrest, and intubation
  • Aspiration pneumonitis
  • Cardiac arrhythmias

As one of the many ways alcohol use can kill you, delirium tremens is a serious condition that should not be ignored. Risk factors for DTs patients are increased when the individual has more than one health risk as a result of substance abuse. Other factors like hepatitis, cirrhosis of the liver, and mental health conditions can add additional risk to the lives of DTs patients.

While only a small percentage of those detoxing from alcohol develop delirium tremens and any symptoms from withdrawal, it is highly recommended that those experiencing symptoms of any kind seek medical treatment when withdrawing. Without the proper treatment, there is a 15 – 40 percent mortality rate for patients with DTs.

Patient Diagnosis

Tests conducted for delirium tremens might include urine, blood-phosphate level, blood-magnesium level, comprehensive metabolic panels, electrocardiograms, or a toxicology screen. However, the only true diagnosis for delirium tremens lies in the hands of a medical professional. Again, it is not recommended to endure withdrawal symptoms without professional oversight.

Some individuals are more likely to fall into the DTs category than others. Below is a list of the risk factors for DTs diagnosis:

  • Prior ethanol withdrawal seizures
  • History of DTs
  • Concurrent illness and more medical comorbidities
  • Daily heavy and prolonged ethanol consumption
  • Greater number of days since last drink
  • Severe withdrawal symptoms at presentation
  • Prior detoxification
  • Intense craving for alcohol
  • Older age
  • Hypokalemia
  • Thrombocytopenia
  • The elevated blood level of homocysteine
  • Presence of structural brain lesions

Nathaniel Rateliff & His Night Sweats

The popular song “S.O.B.” by Nathaniel Rateliff & The Night Sweats is a great example of musical genius in the form of overt alcoholism, but his habit will likely catch up with him one day. After the “night sweat” symptoms are diminished in treatment, the long-term cure for DTs involves a commitment to a local support group and a sponsor that works with you to start a new lifestyle.

A Look at Treatment for Delirium Tremens

From opium to Naltrexone, treatment for alcoholism has changed over the centuries. The Sinclair Method is one of the most modern approaches to treating alcoholism but is also one of the most ineffective methods for treating Delirium tremens. While Delirium tremens can be deadly in the initial few hours of symptoms, Naltrexone remains a treatment option that is only effective in preventing DTs, not treating them. The most effective route for treatment, once diagnosed, is with direct supervision and monitoring by medical staff for a week in a detox facility. Once symptoms of withdrawal show, it is imperative the patient enters a detox rehab facility.

Treatments during detoxification for Delirium tremens may include:

  • Intravenous fluid for dehydration
  • Anticonvulsants for the seizures
  • Sedatives to ease aggravation and anxiety
  • Antipsychotic medication to prevent hallucinations
  • Fever medication, and
  • Any other medication is needed for comfort with any other alcohol-related conditions.

Initial detox with Delirium tremens may take a week or two until the patient is ready to enter long-term treatment for alcoholism.

Symptoms may subside around a week after beginning treatment, and some symptoms may last a while longer. During treatment, many patients show signs of intense discomfort and a great need for medical attention with multiple symptoms. Beginning alcohol detox in a medical facility is the safest option, as the effects can be deadly.

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