Delirium Tremens: Symptoms, Causes, Treatment

It is more than isolated hallucinations or shaking. Other withdrawal symptoms can occur without delirium, but confusion or rapid deterioration calls for emergency assessment.

Related reading: Opioid withdrawal as a different condition requiring its own care.

Fluctuating confusion, agitation, tremor, sweating, fever and fast pulse may occur with hallucinations or seizures. The person may be disoriented or unable to understand events.

Abrupt cessation or a major reduction after physical dependence can produce excessive nervous-system activity. Timing varies; do not wait for a particular interval before seeking help.

Previous severe withdrawal or delirium, prolonged heavy use, repeated withdrawal, poor nutrition, other illnesses or sedative use increase risk.

Emergency assessment checks consciousness, vital signs, alcohol and medication history, glucose, electrolytes and organ function. Infection, head injury and other delirium causes must be considered.

Treatment involves close monitoring, clinician-adjusted withdrawal medicines, thiamine, fluid and electrolyte correction and complication management. Intensive care may be necessary; home sedative recipes are unsafe.

Seizures, cardiac instability, severe dehydration, organ injury or death can occur. Thiamine deficiency may cause additional neurological problems; early treatment reduces risk.

If physically dependent, obtain a medical stopping plan before major abrupt changes, especially after severe previous withdrawal. Continuing care addresses alcohol-use disorder and psychological and social support.