Delirium Tremens

Abstract

• Delirium tremens (DTs) is a medical emergency.

• It occurs in approximately 5% of patients who present with alcohol withdrawal seizures.

• The onset of DTs is acute, manifesting as profound confusion, delusion, vivid visual hallucinations, tremor, agitation, insomnia, nausea and vomiting, and autonomic hyperactivity (dilated pupils, fever, tachycardia, profuse sweating, orthostatic hypotension).

• The onset of DTs is about 48–96 hours after cessation of alcohol intake (patients are often hospitalized for a different reason) and usually resolves in 3–4 days after treatment.

• Patients with DTs should be investigated for underlying medical conditions such as infection, pancreatitis, liver disease, or subdural hematoma.

• Mortality from DTs in untreated cases is about 5%; this is resulting from circulatory collapse, cardiac arrhythmia, hyperthermia, and infection.

• Although the diagnosis of DTs is clinical, all patients should have a complete blood count, coagulation studies, serum amylase, blood chemistry, chest X-ray, spinal tap, and head computed tomography scan.

• Although DTs is not due to thiamine deficiency, thiamine is given to prevent the development of Wernicke’s encephalopathy.