Delirium tremens

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Overview

Symptoms

Treatment

Prevention

Delirium tremens

Alternative Names:

DT's; Alcohol withdrawal - delirium tremens

Symptoms:

Symptoms of alcohol withdrawal
- Feeling jumpy or nervous
- Feeling shaky
- Anxiety
- Irritability or easily excited
- Emotional volatility, rapid emotional changes
- Depression
- Fatigue
- Difficulty thinking clearly
- Palpitations (sensation of feeling the heart beat)
- Headache, general, pulsating
- Sweating, especially the palms of the hands or the face
- Nausea
- Vomiting
- Loss of appetite
- Insomnia (difficulty falling and staying asleep)
- Pale skin
Mental status changes
- Mood changes rapidly
- Restlessness, excitement
- Increased activity
- Decreased attention span
- Excitement
- Fear
- Confusion, disorientation
- Agitation, irritability
- Hallucinations (visual hallucinations such as seeing things that are not present are most common)
- Sensory hyperacuity (highly sensitive to light, sound, touch)
- Delirium (severe, acute loss of mental functions)
- Decreased mental status
  - Stupor, sleepiness, lethargy
  - Deep sleep that persists for a day or longer
  - Usually occurs after acute symptoms
Seizures
- Usually generalized tonic-clonic seizures
- Most common in first 24 - 48 hours
- Most common in people with previous alcohol withdrawal complications
Body tremors

Additional symptoms that may be occur:

Symptoms most commonly occur within 72 hours after the last drink, but may occur up to 7 - 10 days after the last drink. Symptoms may progress rapidly.

Signs and tests:

Delirium tremens is a medical emergency. The health care provider should be consulted promptly.

An examination of the neuromuscular system may show an increased startle reflex, rapid rhythmic muscle tremor, or other changes indicating alcohol withdrawal. Evidence of increased autonomic function -- such as profuse sweating -- may be present.

There may be symptoms of dehydration or malnutrition, and signs indicating electrolyte disturbances. An eye inspection may show abnormalities of eye muscle movement -- such as lid lag. The heart rate may be rapid, and there may be an irregular heart beat. The blood pressure may be normal, elevated, or low.

A serum toxicology screen is usually positive for alcohol. Serum chemistry (chem-20) may show electrolyte disturbances, especially decreased levels of potassium and magnesium. An ECG (electrocardiogram) may show arrhythmias. An EEG (electroencephalogram) may be performed to rule out other causes of seizures.

Review Date: 2/9/2005
Reviewed By: Thomas A. Owens, M.D., Departments of Internal Medicine and Pediatrics, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.

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