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Delirium tremens

This article is about the medical emergency. For alcohol withdrawal in general, see Alcohol withdrawal syndrome.
"DTs" and "The shakes" redirect here. For other uses, see DTs (disambiguation) and The shakes (disambiguation).
For other uses, see Delirium tremens (disambiguation).
Delirium tremens
An alcoholic man with delirium tremens on his deathbed, surrounded by his concerned family. The text L'alcool tue means "Alcohol kills" in French.
SpecialtyPsychiatry, critical care medicine
SymptomsHallucinations, confusion, shaking, shivering, irregular heart rate, sweating[1][2]
ComplicationsVery high body temperature, seizures[2]
Usual onsetRapid[2]
Duration2–3 days[2]
CausesAbrupt cessation of alcohol intake in a state of alcohol dependence
Differential diagnosisBenzodiazepine withdrawal syndrome, barbiturate withdrawal[3]
TreatmentIntensive care unit, benzodiazepines, thiamine[2]
PrognosisRisk of death ~2% (treatment), 25% (no treatment)[4]
Frequency~4% of those withdrawing from alcohol[2]

Delirium tremens (DTs; lit. 'mental disturbance with shaking') is a rapid onset of confusion usually caused by withdrawal from alcohol.[2] When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days.[2] Physical effects may include shaking, shivering, irregular heart rate, and sweating.[1] People may also hallucinate.[2] Occasionally, a very high body temperature or seizures (colloquially known as "rum fits")[5][6] may result in death.[2]

Delirium tremens typically occurs only in people with a high intake of alcohol for more than a month, followed by sharply reduced intake.[7] A similar syndrome may occur with benzodiazepine and barbiturate withdrawal. In a person with delirium tremens, it is important to rule out other associated problems such as electrolyte abnormalities, pancreatitis, and alcoholic hepatitis.[2]

Prevention is by treating withdrawal symptoms using similarly acting compounds to taper off the use of the precipitating substance in a controlled fashion.[2] If delirium tremens occurs, aggressive treatment improves outcomes.[2] Treatment in a quiet intensive care unit with sufficient light is often recommended.[2] Benzodiazepines are the medication of choice with diazepam, lorazepam, chlordiazepoxide, and oxazepam all commonly used.[7] They should be given until a person is lightly sleeping.[2] Nonbenzodiazepines are often used as adjuncts to manage the sleep disturbance associated with condition. The antipsychotic haloperidol may also be used[2] in order to combat the overactivity and possible excitotoxicity caused by the withdrawal from a GABA-ergic substance. Thiamine (vitamin B1) is recommended to be given intramuscularly,[2] because long-term high alcohol intake and the often attendant nutritional deficit damages the small intestine, leading to a thiamine deficiency, which sometimes cannot be rectified by supplement pills alone.

Mortality without treatment is between 15% and 40%.[4] Currently death occurs in about 1% to 4% of cases.[2]

About half of people with alcoholism will develop withdrawal symptoms upon reducing their use.[2] Of these, 3% to 5% develop DTs or have seizures.[2]

The name delirium tremens was first used in 1813; however, the symptoms were well described since the 1700s.[7] The word "delirium" is Latin for "going off the furrow," a plowing metaphor for disordered thinking.[4] It is also called the shaking frenzy and Saunders-Sutton syndrome.[4] There are numerous nicknames for the condition, including "the DTs" and "seeing pink elephants".

  1. ^ a b Healy, David (3 December 2008). Psychiatric Drugs Explained. Elsevier Health Sciences. p. 237. ISBN 978-0-7020-2997-4. Archived from the original on 8 September 2017.
  2. ^ a b c d e f g h i j k l m n o p q r s t Schuckit, MA (27 November 2014). "Recognition and management of withdrawal delirium (delirium tremens)". The New England Journal of Medicine. 371 (22): 2109–13. doi:10.1056/NEJMra1407298. PMID 25427113. S2CID 205116954.
  3. ^ Posner, Jerome B. (2007). Plum and Posner's Diagnosis of Stupor and Coma (4 ed.). Oxford: Oxford University Press, USA. p. 283. ISBN 9780198043362. Archived from the original on 2016-03-04.
  4. ^ a b c d Blom, Jan Dirk (2010). A dictionary of hallucinations (. ed.). New York: Springer. p. 136. ISBN 9781441912237. Archived from the original on 2016-03-04.
  5. ^ "rum fits". Medical dictionary. Farlex, Inc. Retrieved 22 November 2022.
  6. ^ Rhinehart, John W. (1961). "Factors determining "rum fits"". American Journal of Psychiatry. 118 (3): 251–252. doi:10.1176/ajp.118.3.251. ISSN 0002-953X. PMID 13741146. Retrieved 1 February 2023.
  7. ^ a b c Stern, TA; Gross, AF; Stern, TW; Nejad, SH; Maldonado, JR (2010). "Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles"". Primary Care Companion to the Journal of Clinical Psychiatry. 12 (3). doi:10.4088/PCC.10r00991ecr. PMC 2947546. PMID 20944765.
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