Delirium tremens
From Drug Rehab Wiki
Delirium tremens is the most severe form of alcohol withdrawal (characterized by violent delirium with tremors) and causes sudden critical mental and neurological changes. Delirium tremens (also known as alcohol withdrawal delirium, the DTs, “the fear,” or “the horrors”) afflicts about 5 percent of hospitalized alcoholics. The condition is most common among drinkers with an extensive history of alcohol overindulgence or alcoholism for over 10 years. These individuals are typically characterized as habitual drinkers if they consume an average of 7–8 pints of beer, 4–5 pints of wine, or 1 pint of hard liquor per day for an extended period of time. Delirium tremens occurs after the habitual drinker abruptly stops consumption after a physical dependence has been fully developed. It may also occur in individuals after a period of heavy alcohol consumption, especially if the individual did not consume any food. In other situations, the condition may be induced by head injury, infection, or illness in someone who has a history of habitual alcohol consumption. Although cases of delirium tremens are rare, the condition has a high mortality rate (over 35% of cases if untreated) and should be regarded as a medical emergency.
Delirium tremens is literally manifested by sympathetic nervous system overdrive and acute alteration of mental state, which can rapidly progress to cardiovascular collapse. It typically occurs within 24–72 hours after abstinence of alcohol, but it can even occur up to 7–10 days after the last drink. Delirium tremens usually lasts between 1–3 days, and can end just as sudden as it began. However, relapses may occur, and periods of hallucinatory states may break amidst periods of lucidity. The condition was first described by Dr. Thomas Sutton in an 1813 medical publication, and then linked to alcohol withdrawal by Victor and Adams in 1953. Delirium tremens may be similar to alcoholic hallucinosis, alcoholic tremulousness, and alcohol withdrawal seizures, but only delirium tremens has the immediate risk of mortality. Symptoms of alcohol withdrawal include: headache, fatigue, anxiety, depression, insomnia, irritability, excitability, nervousness, sudden mood swings, difficulty thinking clearly, shakiness, loss of appetite, nausea, perspiration, pale skin, and vomiting. Signs of alcohol withdrawal, in combination with body tremors, alteration of mental state, and even seizures may indicate the occurrence of delirium tremens.
Delirium tremens is clinically identified by the following symptoms: agitated arousal, total confusion or disorientation, decreased attention span, and intense or threatening delusions and hallucinations. Delirium tremens is more specifically identified by sympathetic hyperactivity including tremor, fever, hyperpyrexia, tachycardia, severe diaphoresis, hypertension, mydriasis, and delirium. Hallucinations are typically visual, but tactical hallucinations are common as well.
It is vital that such an individual be hospitalized in the case of delirium tremens. Once delirium tremens has been identified in a patient, the primary goal of treatment is to save the patient’s life. A hospital staff will attempt to relieve the patient’s symptoms and prevent further complications by checking vital signs, monitoring blood chemistry and body fluids, and treating/preventing seizures and heart arrhythmias. Benzodiazepines such as Valium and Xanax are often used to alleviate the symptoms, and a physician may also use sedatives or place the patient in a sedated state until withdrawal is complete to avoid seizures and other complications. These patients will have a high tolerance to sedatives due to their habitual alcohol use, so intravenous doses must carefully be administered by a professional medical staff. Treatment of seizures may include anticonvulsants and central nervous symptom depressants such as Phenobarbital, phenytoin, and diazepam. Antipsychotic medication such as haloperidol, midazolam (Versed), or temazepam (Restoril) may be given to treat hallucinations. Clonidine may be prescribed to help alleviate anxiety and prevent circulatory collapse.
If not properly treated, such conditions as Wernicke’s encephalopathy, liver disease, cardiomyopathy, and blood clotting disorders may result. After treatment for delirium tremens, patients should receive counseling and be referred to support groups for further assistance and rehabilitation. Alcoholic relapse may prove fatal. The patient should consider long-term preventative care and abstinence.
