Delirium tremens is a life-threatening form of alcohol withdrawal. While treatable, this condition needs immediate medical care. This condition is avoidable with professional medical guidance and specialized programs that help people who want to lower their alcohol intake or stop drinking entirely.
Delirium tremens (DTs) is the most severe form of alcohol withdrawal. This condition can sometimes be life-threatening. DTs is possible when someone with alcohol use disorder, especially moderate or severe alcohol use disorder, suddenly stops drinking entirely.
Long-term heavy alcohol use sets up a tug-of-war-like effect in your body. Alcohol is on one side, slowing down central nervous system (CNS) activity. Your CNS controls your body’s automatic processes like breathing and heart rate. Alcohol is a depressant, so it slows down this activity. Your CNS is on the other side of the rope pulling back by increasing its own activity to keep things running. Over time, your CNS adjusts and sees that increased activity level as its new normal.
If you suddenly stop drinking, it’s like the alcohol side letting go of the rope. Suddenly, your CNS doesn’t have to pull back against alcohol to keep activity at a proper level. But your CNS can’t bring its activity level down quickly. That means your CNS is much more active than needed, to the point that it negatively affects automatic body processes. This causes DTs.
Alcohol use disorder is common. About 29% of adults in the U.S. will meet the criteria for it at some point in their lifetime. Of those people, approximately 1% to 1.5% will have DTs.
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There are many possible symptoms of DTs, and some are more well-known than others. The symptoms can include:
The only cause of DTs is withdrawal that happens when someone with alcohol use disorder stops drinking alcohol suddenly. They usually appear between one and three days after your last drink and are usually most intense four to five days after your last drink.
Several risk factors can make DTs more likely to happen. They include:
Alcohol use disorder and DTs can both contribute to a number of complications, many of them serious. They include:
A healthcare provider, typically an emergency room physician or other clinician, can diagnose DTs based on a combination of methods and tools. These include:
Most of the tests that help diagnose DTs happen in the laboratory and involve blood or urine samples. The tests look for issues with the following:
Other tests may be possible, depending on your symptoms or if you have any other health problems. Your healthcare provider can tell you more about the tests they recommend or used for you (or your loved one) and why.
DTs isn’t curable, but it’s very treatable. Because confusion is a key symptom of DTs, people with this condition can’t make informed choices about their care. It may be necessary for family or loved ones to make decisions if you can’t make choices for yourself.
One of the priorities in treating this condition is to lower nervous system activity. A healthcare provider will treat this using drugs that reduce how active your CNS is. Multiple types of medication can help with this.
Treating DTs generally starts with sedatives. They help lower activity in your CNS, which is the source of most of the dangerous problems with DTs. The most common sedatives are benzodiazepines, but other drug types are possible, too. In rare situations, people with very high CNS activity may need general anesthesia to fully sedate them and avoid the most dangerous symptoms of DTs.
Many people with DTs also have dehydration, electrolyte imbalances or mineral deficiencies. Your healthcare provider can treat these by infusing you (through an IV in your vein) with the necessary vitamins and minerals. Some infusions come specially prepared for this type of situation. An example of this is an infusion that healthcare providers often refer to by the nickname “banana bag” (because the solution in them is yellow). It contains vitamin B1 (thiamine), B9 (folate), a multivitamin, electrolyte solution and more.
The main underlying issue that causes DTs is alcohol use disorder. The long-term goal after treating DTs is to treat alcohol use disorder. There are many treatment approaches for alcohol use disorder. Receiving treatment for it can help reduce the odds of developing DTs in the future.
Complications of DTs treatments largely depend on the treatments you receive. Because there are many different medications and treatment approaches, the side effects can vary widely. Your healthcare provider is the best person to tell you more about the possible complications you might experience after your symptoms improve and confusion resolves. Your provider may also tell loved ones authorized to know and make choices about your care.
The main symptoms of DTs often take between three to seven days to go away. You should start to feel better gradually during that time. In severe cases, you may experience some symptoms for weeks to months.
The only definitive way to prevent DTs is to avoid alcohol entirely.
If you have alcohol use disorder and want to stop drinking, talk to a healthcare provider. They can help you find resources, care and support that’ll help you reduce alcohol intake safely, and also give you the best chance at a positive outcome. They can recommend alcohol rehabilitation programs, specialist providers, support groups and more.
The best way to avoid or reduce your risk of developing alcohol use disorder (and DTs) is to drink in moderation. That means drinking according to the following guidelines:
Alcohol use disorder isn’t a condition that happens for just one reason. Family history, mental health conditions and many other factors can play a role. If you’re concerned about your risks for developing alcohol use disorder, it’s a good idea to talk to a healthcare provider. They can help you understand your risks and guide you on what to do about them.
One drink is equal to 14 grams (g.) of pure alcohol, which can take many different forms because some forms have a higher concentration of alcohol than others.
Each of the following examples of those forms is equal to one drink.
|Beer||Malt liquor||Wine||Liquor (Bourbon, Gin, Rum, Tequila, Vodka, Whiskey)|
|5% alcohol by volume (ABV)||7% ABV||12% ABV||40% ABV|
|12 fluid ounces||8 to 9 fluid ounces||5 fluid ounces||1.5 fluid ounces|
|5% alcohol by volume (ABV)|
|12 fluid ounces|
|8 to 9 fluid ounces|
|5 fluid ounces|
If you have delirium tremens, confusion is one of the key symptoms you’ll experience. You’ll have trouble understanding what’s happening to or around you. It’s also possible that you’ll experience hallucinations, meaning you’ll see or hear things that seem real to you, but that aren’t really there.
Because of these symptoms, you won’t be able to make decisions about your medical care. Healthcare providers will treat you to stabilize you (unless you have some kind of advance medical directive on file with them). They may also talk to family, friends or loved ones you previously approved to know and make decisions about your medical care.
DTs generally lasts up to seven days. Some people may experience some symptoms for up to two weeks.
The outlook for delirium tremens depends on multiple factors. Those include:
Even with treatment, one of the possible complications of DTs is death. Without treatment, about 15% of people with DTs don’t survive. The risk of death is also higher if you have other severe medical conditions. With treatment, the survival rate of DTs is about 95%. The earlier a person gets treatment for DTs, the better the odds of survival and a positive outcome.
DTs can develop in anyone who meets the criteria for heavy alcohol use. For people AMAB, that means drinking three or more drinks per day and 15 or more drinks per week. For people AFAB, that means drinking two or more drinks per day and eight or more drinks per week. However, DTs becomes more and more likely the more you drink and the longer this continues.
It’s hard to pinpoint an exact number for each person because everyone’s different. Some people have higher alcohol tolerances. Some have genetic conditions that mean it’s very easy for them to experience intoxication from alcohol. Others may be more susceptible to intoxication and DTs because of medications they take, health conditions and other factors.
Because DTs can happen to people at various drinking levels, the best way to avoid DTs is to drink in moderation or not at all.
A note from Cleveland Clinic
Delirium tremens is a severe, life-threatening form of withdrawal that can happen when a person with alcohol use disorder suddenly stops drinking. Reducing alcohol intake or quitting alcohol entirely is an important step toward improving your health if you have alcohol use disorder. But this is a goal you should also approach safely, and you don’t have to do it alone.
If you have alcohol use disorder and want to reduce how much you drink or quit entirely, a primary care provider can guide you to resources and rehabilitation programs that can help. Many people feel shame or embarrassment asking for this kind of help, but your provider’s job is to help, not to judge. That way, you can reduce your drinking safely and improve your health, well-being and overall quality of life.
Last reviewed by a Cleveland Clinic medical professional on 06/05/2023.
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