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Delirium Tremens

    Delirium Tremens

    When a person who is physically addicted to alcohol abruptly stops drinking, they are likely to experience a range of alcohol withdrawal symptoms including nausea, shakiness and confusion.

    The most severe form of alcohol withdrawal is delirium tremens (DTs) which can affect 5-10% of alcohol-dependent people, usually occurring within 48 hours of the last drink and lasting for up to five days.

    It is vital to be aware of the warning signs and take immediate action if delirium tremens is suspected, as in some cases it can lead to severe complications including seizures, respiratory failure and even loss of life.

    What is delirium tremens?

    Delirium tremens was first officially recognised in 1813 and is a highly dangerous withdrawal symptom that can result in many serious complications. It has a mortality rate of up to 37% if left untreated, so it is crucial that anyone attempting to withdraw from alcohol does so in a supervised medical setting. [1]

    Many people are not aware that the body can become physically addicted to alcohol, meaning that it is unable to function normally without it. Drinking alcohol on a regular basis, particularly to the extent that physical dependence is formed, disrupts the natural balance of chemicals in the brain.

    The body can become used to this imbalance and consequently works harder to keep itself functioning. When the alcohol is suddenly taken away, the body continues to perform in a hyper-alert state which can result in withdrawal symptoms and in severe cases can lead to delirium tremens. [2]

    What are the symptoms of delirium tremens?

    Mild to moderate alcohol withdrawal symptoms can develop into delirium tremens very quickly, often in a matter of hours. It’s important to watch out for the warning signs if you or someone you know is going through alcohol withdrawal – this is why it is recommended to detox from alcohol in a rehabilitation setting, as a medical professional will be trained to spot the symptoms of delirium tremens.

    An individual who is experiencing delirium tremens can present with a number of physical, behavioural and psychological symptoms.

    Physical symptoms of delirium tremens include:

    • Hallucinations
    • Loss of consciousness
    • Convulsions and seizures
    • High blood pressure
    • Feverish and/or flu-like symptoms
    • Excessive perspiration
    • Rapid heartbeat
    • Dehydration
    • Sensitivity to light
    • Body tremors
    • Hypothermia

    Behavioural symptoms of delirium tremens include:

    • Hyperactivity
    • Appearing agitated or nervous
    • Acting impulsively

    Psychological symptoms of delirium tremens include:

    • Confusion and disorientation
    • Psychosis
    • Disturbed sleep, trouble falling or staying asleep

    It can be difficult to know whether someone is suffering from delirium tremens or whether their symptoms are part of the withdrawal process. It’s better to be safe than sorry – if you are concerned that you or someone you know may be experiencing delirium tremors, contact emergency medical services immediately.

    Who is most at risk of delirium tremens?

    People of certain demographics are statistically more likely to experience delirium tremens, although it can happen to anyone who attempts to drastically reduce or completely stop their alcohol intake.

    Research shows that there is a higher prevalence of delirium tremens in adult males of Caucasian descent, particularly those who are unmarried. [1] However, there are a number of risk factors involved that can make it more likely for a person of any age, gender and ethnicity to develop this highly dangerous withdrawal symptom.

    Risk factors for delirium tremens include:

    • Long-term severe alcohol dependency
    • Previous experience of delirium tremens
    • Previous experience of seizures caused by alcohol withdrawal
    • Low potassium levels
    • Other illnesses co-occurring alongside alcohol withdrawal

    If a person has experienced delirium tremens or other alcohol withdrawal symptoms in the past, they are statistically more likely to develop them again. Repeated instances of delirium tremens can result in more aggressive symptoms, an increased risk of long-term complications and a greater likelihood of death.

    How is delirium tremens diagnosed?

    It can be difficult to quickly diagnose delirium tremens, as the symptoms can appear very similar to other conditions such as alcoholic hepatitis or pancreatitis.

    If some of the above symptoms are apparent, it is important to seek medical assistance immediately. Providing a full medical history including any previous withdrawal attempts along with information about the duration and extent of the alcohol addiction will be extremely helpful in determining whether the symptoms are related to delirium tremens.

    It is also important to provide details of when the patient’s last alcoholic drink was consumed, as this can give a greater indication as to the severity of the symptoms.

    A physical examination and blood tests will usually be conducted in order to rule out any underlying conditions. Even if delirium tremens is initially suspected, it is important to eliminate any other potential illnesses.

    The following criteria taken from the medical Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) is often used to determine whether delirium tremens is present.

    • The individual has reduced or stopped their alcohol intake
    • Seeing, hearing or feeling things that aren’t there
    • Experiencing seizures
    • Feelings of stress, worry and anxiety
    • Excessive perspiration, heart palpitations
    • Shaking hands
    • Low attention span, poor judgement, confusion
    • Disturbed sleep, trouble falling or staying asleep
    • Physical sickness
    • Restlessness
    • Low attention span, poor judgement, confusion
    • The individual is not suffering from a co-occurring brain condition

    A suspected case of delirium tremens will be taken very seriously by medical professionals, as there is a chance of severe seizure or even death without proper treatment.

    What are the potential complications from delirium tremens?

    Even when delirium tremens is caught in time, in certain cases it can still lead to serious medical complications. Any one of these conditions can have a detrimental effect on a person’s wellbeing and future health outcomes, so it is vital that alcohol withdrawal and detoxification takes place under the care of a trained medical professional.

    Potential complications from delirium tremens include:

    • Respiratory failure
    • Arrhythmias
    • Hypothermia
    • Hypertension
    • Seizures
    • Aspiration pneumonitis
    • Global confusion

    Thankfully, the mortality rate of delirium tremens has decreased in recent years and a number of treatments have been developed to help lessen symptoms and aid recovery.

    However, if a patient has gone through delirium tremens multiple times, studies show that they are at greater risk of developing long-term complications.

    How is delirium tremens treated?

    When caught early enough, delirium tremens can be successfully treated and many patients go on to make a full recovery.

    The following treatments should be administered by trained medical professionals. Do not attempt to diagnose and treat delirium tremens at home.

    There are a number of medications that can be used to treat delirium tremens with the most common being benzodiazepines – namely Valium, Ativan or Librium. Used on either a fixed schedule or as symptoms appear, this help to calm the hyper-alert nervous system and bring it back down to a regular level, alleviating many of the withdrawal symptoms. [1]

    Another way to rebalance the body’s chemical levels is the use of intravenous fluids containing electrolytes or vitamins.

    If hallucinations are present, the use of antipsychotic drugs may be required. Anticonvulsants are also used to reduce and eliminate the risk of seizures along with pain medication and various blood pressure medications. However, these are generally not recommended and should be avoided if possible due to a lack of research to show their effects on alcohol withdrawal.

    Recovery from delirium tremens generally involves a hospital stay of up to one week. Once discharged, the patient is encouraged to seek help for their alcohol addiction through the use of specialised rehabilitation programmes.

    Recovery after delirium tremens

    A hospital stay and the alleviation of physical withdrawal symptoms should not be the only treatment offered to patients who have experienced delirium tremens. The period of time following alcohol withdrawal is when the individual is most likely to relapse, and support and guidance are needed to increase the chances of a full recovery from alcohol addiction.

    It is vital that professional treatment is sought during this time to prevent relapse, as multiple occurrences of delirium tremens can lead to severe complications and an increased mortality rate.

    Many people choose to attend self-help meetings and support groups such as Alcoholics Anonymous. This is a great way to build a network of peers who have similar or shared experiences, lessening the feelings of isolation and loneliness that can cause addicts to relapse.

    It can also be helpful to attend cognitive behavioural therapy in order to identify unhelpful behaviours and thought patterns while learning positive coping mechanisms. Both individual and group therapy sessions have been proven to assist in addiction recovery, while a psychiatric assessment can prove invaluable when diagnosing co-occurring disorders and prescribing medication.

    Although the onset of delirium tremens can be a scary and unpleasant experience, it is also an opportunity to recognise the detrimental effect that alcohol is having on your life, health and general happiness. Now is the time to make a change.

    With the help of professional rehabilitation services, many people have gone on to live a life free from alcohol addiction.

    Get in touch today with our team here at OK Rehab – we can guide you in selecting the treatment programme that is best suited for you and your needs.

    References

    [1] https://www.ncbi.nlm.nih.gov/books/NBK482134/

    [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085800/

     

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