Delirium Tremens

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If you or a loved one is suffering from Alcohol Withdrawal Syndrome, schedule an appointment with a qualified therapist. In case of seizures or delirium tremens, go to your nearest emergency room.

What is Delirium Tremens?

This is the most severe stage of alcohol withdrawal that typically affects people with a history of heavy drinking. The condition is rare, so it doesn’t affect everyone who experiences alcohol withdrawal. However, it can be potentially fatal and mostly affects people who have experienced severe withdrawal symptoms before, with is about 5 percent of people who regularly abuse alcohol. These symptoms are different from regular alcohol withdrawal symptoms.

Risk Factors and Causes of Delirium Tremens

Simply drinking alcohol doesn’t increase your risk of developing delirium tremens. Some of the most common risk factors include a 10-year history of chronic alcoholism, history of delirium tremens, experiencing stage two of alcohol withdrawal syndrome, and going on for many days without alcohol when you have a dependency. Underlying health concerns, such as heart or liver disease, or traumatic brain injury can also increase one’s risk of facing delirium tremens.

Some of the less common risk factors include an infection in the central nervous system, a history of seizures, head injury, and malnutrition. It’s important to remember that no single factor leads to its development.

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Why it Happens

When you drink alcohol, it changes your body’s inhibitory and excitatory mechanisms, which leads to a slowdown of brain function. Because of this sedative effect, you experience low anxiety. With persistent alcohol consumption, the brain undergoes permanent changes to allow continuously high level of alcohol in the blood. This leads to one drinking an increasing amount of alcohol to experience the same effects, called tolerance.

With time, you develop dependence, and if alcohol consumption is reduced significantly, the brain keeps forming excitatory signals to make up for alcohol’s inhibitory effects. As the degree of overcompensation increases, the brain makes more excitatory signals, which manifest as hyper-arousal. It explains why a person experiencing alcohol withdrawal seems agitated.

Spotting Symptoms of Delirium Tremens

One of the biggest symptoms of delirium tremens includes withdrawal seizures. Then, there are signs such as:


They may feel very confused about what’s happing around them and to them. They may also be disoriented, which is when you can’t answer simple questions and are detached from reality.


The body isn’t maintaining homeostasis during delirium tremens, so you may sweat due to the body’s inability to regulate temperature. Other symptoms include fevers, and hot and cold flashes.

Irregular Heart Rate

They may show palpitations, their heart may start skipping beats or race uncontrollably. This means a heart rate of over 100 beats per minute (tachycardia).

Shivering and Shaking

You may shiver due to a fever and experience uncontrollable shaking in the hands.


You may start hearing and seeing things that aren’t there, which increases feelings of confusion.

Diagnosing Delirium Tremens

To diagnose a person with delirium tremens, they should show two major aspects. The patient should suffer from delirium, as well as severe alcohol withdrawal. Delirium manifests as rapid onset of disturbances in consciousness, the sleep-wake cycle, and psychomotor activity.

Your doctor may also diagnose you for alcohol dependence, which includes signs like low control over alcohol consumption, increasingly prioritizing alcohol, and experiencing adverse mental or physical effects as a result of drinking.


For people struggling with delirium tremens, symptoms start around 2 to 4 days after they had their last drink. Because it’s the third stage of Alcohol Withdrawal Syndrome, not all people come to experience it. They will go through the following stages first:


When a person suffers from AWS, the first stage begins almost a day after they’ve had their last drink, but it can occur as early as 8 hours as well. In this stage, you experience heightened anxiety, headaches, and have trouble sleeping.


The second stage starts around 3 to 4 days after the last drink. In this stage, you face symptoms like heightened blood pressure, nausea, and sweating. After these minor symptoms, you risk experiencing visual and auditory hallucinations.


In severe cases of alcohol withdrawal, you undergo the third stage, which involves extreme symptoms such as violent muscle contractions and losing consciousness. Without timely intervention, you risk going into a coma.


The easiest way to avoid the symptoms of delirium tremens is to avoid alcohol consumption. If you do choose to drink it, take it in smaller amounts according to CDC guidelines. The CDC recommends that men should have two drinks or less per day, while women should have one drink or less per day.
One drink is the equivalent of 12 ounces of beer with a 5% ABV, or 5 ounces of wine with 12% ABV. Although there’s no safe amount of alcohol, staying within these limits lowers your risk of experiencing adverse effects.

Strategies like not drinking at social gatherings and avoiding social circles that encourage drinking are suitable for someone who has not yet experienced alcohol dependence. However, people suffering from alcohol withdrawal syndrome should not attempt to detoxify their body without appropriate medical assistance. Prompt medical treatment of alcohol withdrawal can help reduce the risk of symptoms exacerbating and turning into delirium tremens.


When treating delirium tremens, the main goals of a medical professional include reducing agitation, alleviating the risk of seizures, and decreasing mortality. One the patient stabilizes; they will have to undergo rehabilitative therapy at a clinic.

There, alcohol withdrawal syndrome therapy will begin with a detoxification program to help your body gradually adjust to the absence of alcohol. Of course, there is a likelihood of experiencing withdrawal symptoms, which is why medical professionals prescribe certain medications to help the body combat them. The most common of these are benzodiazepines, such as lorazepam and diazepam.

Besides detoxifying the body, you will have to see a therapist, who may suggest family or group therapy aside from counseling. These services can help you stay accountable and stick to a treatment regimen. Moreover, they surround you with a supportive community and encourage your family to participate with your treatment journey.