Did you know that alcohol withdrawal is the most risky type of withdrawal from a substance? This is largely due to Delirium Tremens.
Delirium Tremens (DT) is a withdrawal symptom of abstaining from alcohol. It’s a little more complicated than that as there are certain alcoholics who are more at risk. It doesn’t often happen to a casual drinker or the typical high-functioning alcoholic. DT is most likely to happen in someone who is a heavy drinker. It’s the most severe type of withdrawal for alcoholics and can be quite dangerous. There is the potential of death which is heightened when you don’t have medical assistance. DT has a lot of names as it was originally diagnosed back in the 1700’s. Some of the more common names in modern times include shaking frenzy or Saunders-Sutton syndrome.
DT is a sudden mental or nervous system change due to “global confusion.” DT causes sympathetic overdrive, potentially causing collapse of the cardiovascular system. It’s characterized by hallucinations and no ability to recognize the real world. This is often why it’s recommended that a patient be admitted when withdrawing from alcohol. It’s really important to recognize it at the early stages so it can be treated immediately. Alcohol detox in a clinical setting is advised as there are always risks of withdrawal symptoms. DT is a medical emergency as the death rate is so high.
Delirium tremens are not the same as alcohol hallucinosis. This is not nearly as serious and doesn’t carry the mortality rate of DT. Between 5-10% of alcoholics will experience DT as one of their withdrawal symptoms. The mortality rate is 1-5% with treatment. For those who are not treated when they have DT, the mortality rate is 35%. For anyone who is considered a heavy drinker by medical standards, it’s important to at least contact your doctor when withdrawing from alcohol.
How DT’s are Associated with Alcoholism
When someone drinks chronically, it eventually affects the neurotransmitter systems. GABA receptors will work to modulate the chemicals that are changing the brain. When you withdraw, these receptors will often malfunction. GABA receptors not only maintain the systems of neurotransmitters, it also controls your blood pressure, heartrate and seizure threshold. When you withdraw from alcohol, you should seek help first to gauge your risk of having delirium tremens.
As you prompted change in the chemistry of your brain, when you withdraw from alcohol, the receptors that the alcohol altered will quickly change. They contribute to how your mind processes what it’s seeing and experiencing. The brain tells your organs what to do and is the source of what your senses experience. This is why people will experience dizziness or uncontrollable seizures. The receptors may become incapable of functioning properly through withdrawal. This can lead to the delirium and seizures that are prevalent with delirium tremens.
Timeframe of DTs
DTs are fairly predictable when it comes to the connection to alcohol withdrawal in when they will occur and for what reason. The confusion and delirium that occurs with delirium tremens comes on quickly. After your last drink, DTs is expected to occur around three days into withdrawal. It can last for up to three days once it’s begun. Generally, it should taper off 5-7 days later. For this reason, it’s suggested that you seek medical help for the initial stages of alcohol detox. This can be inpatient or outpatient treatment but regardless of what you choose, you’ll want specific medication that will prevent DTs from occurring. Your doctor can prescribe this to you if you want to detox at home. A better option would be to do inpatient detox so you can be monitored throughout the process.
Who is at Risk to get DT’s?
Delirium tremens usually occur in those who have been drinking a lot of alcohol for 30 days or more. They are particularly common for those who have had trouble withdrawing in the past. It also becomes more common when you didn’t eat much during your drinking phase. There is a similar syndrome that happens for people who are withdrawing from barbiturates or benzodiazepine. It’s the abrupt abstaining of these substances that may cause DTs because they all manipulate a similar area of the brain. Someone with electrolyte abnormalities, pancreatitis or alcohol hepatitis are also at risk of DTs. It can be triggered by a head injury, infection or someone who is sick due to heavy drinking for long periods of time.
Those that are at a higher risk include heavy drinkers. This is considered to be 3-4 litres of beer per day or half a litre of spirits per day. They will also be common for the alcoholic who drinks often for a long period of time. This is usually considered to be 10 years or more. Alcoholics who are so dependent that they drink in the mornings to stave withdrawal should use caution when withdrawing. As well, the older you are, the more likely DTs may occur.
Symptoms of Delirium Tremens
There are many symptoms that are associated with DTs other than just the rapid confusion. They may last from 3 days to 7 days. For those doing treatment at home, it’s important to follow the outpatient treatment instructions.
The main symptoms include:
- Global confusion
- Hallucinations of all kinds
- High blood pressure
Typically, these main DTs symptoms will occur in the beginning of alcohol withdrawal. They may come on suddenly in the first two to three days. It has been reported that the symptoms are worse on the fourth or fifth day. They are also worse during the nighttime hours. Many people have said they saw insects, rats, or snakes that weren’t there. It is part of the perceptual disturbance that some may suffer from. Those recovering from alcohol may feel like there is something crawling on them when there is nothing. They may also feel as though something terrible will happen and have severe, uncontrollable anxiety. Some may feel as though they will most certainly die. Not because of the symptoms but a belief that death is imminent.
Mental Side Effects of DTs
- Sudden severe confusion which will manifest as an inability to complete sentences properly.
- Changes in mental function.
- Fear or excitement for no reason.
- Bursts of energy.
- Seeing or feeling things that aren’t there.
- Abrupt mood changes.
- Shaking or shivering.
- Irregular heart rate.
- Severe sweating.
- High fever.
Physical Side Effects of DTs
Delirium Tremens can include severe physical effects. They include;
- Uncontrollable tremors that are quite severe. The general seizure people will get is tonic-clonic (grand mal).
- Panic attacks.
- High pulse rate.
- High blood pressure.
- Deep sleeps that can last for longer than a day.
- Developing a sensitivity to light, sound, and touch.
Long Term DTs Symptoms
DTs may occur through your alcohol recovery for a year or longer. Even if you feel mentally better through holistic treatment, you can still suffer from DTs for quite some time. Some of the long term symptoms associated with DTs include:
- Mood swings.
- Feelings of exhaustion.
- Injury to yourself or others due to rapid confusion or delirium.
Medical Management for Delirium Tremens
Alcohol withdrawal is extremely dangerous and can kill you. It’s worth taking your recovery from alcohol seriously. As symptoms can come on strong very quickly, you won’t be able to get medical help when you need it. Withdrawal symptoms can go from moderate to deadly in a short amount of time with no pre-warning. By getting medical help when you’ve decided to stop drinking, you can help prevent DTs from occurring. It is a part of the inpatient treatment program with any rehabilitation center and can also be part of an outpatient treatment program for alcoholism.
When you decide to get medical management because you’re going to quit drinking, you increase the likelihood of a successful recovery. It is effective enough that you can detox at home without the risk of DTs. You’ll have to see your doctor to get medicated in a clinic but you avoid the dangers of DTs altogether.
How to Prevent the Onset of DT’s
The main way to prevent delirium tremens is to treat withdrawal symptoms. Mortality without treatment while withdrawing from alcohol is 15%-40%. If DTs do occur, aggressive treatments have been shown to improve the outcome. Studies have shown that the most effective treatment should include medical treatment for alcohol in a room that offers the patient sufficient light. Controlling stimuli in a relaxed environment has been shown to reduce stress and visual hallucinations. It’s important for the patient to remain mindful. This may include holistic approaches such as meditation or breathing techniques.
Medical treatment will include giving the person benzodiazepines. They will be administered until the recovering alcoholic is lightly sleeping. To prevent death, it’s possible that high doses of benzodiazepines will need to be given. It depends on the symptoms. Sometimes, the use of antipsychotics are used. For the long-term treatment, medication Acamprosate may be incorporated into alcohol withdrawal treatment. It reduces the risk of relapse, believed to stabilize chemical imbalances in the brain that occur through alcohol withdrawal.
Sometimes, the use of alcohol may be prescribed to prevent DTs. This is not considered to be good practice for most in the addiction treatment industry. What is recommended is thiamine, which may be administered intravenously. A thiamine deficiency in the body along with alcohol can damage the brain further. A thiamine, or Vitamin B1 deficiency can occur through the use of alcohol abuse. Thiamine deficiency along with alcohol abuse will have high risks of effecting the brain in a dangerous way.
Gauging the Risks of Delirium Tremens
The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) is a scale to assess alcohol withdrawal. There are ten components to the test with independent scales of intensity. This helps medical professionals determine when it’s safe for alcoholics to taper off from medication assistance.
Mild alcohol is defined with a score of 15 or less.
Severe alcoholism is 20 or more.
These common symptoms of alcohol withdrawal include:
- Random sweating
- Disturbance in movement.
- Disturbance in eye movement.
- Disturbance of hearing.
- Problems with orientation and the ability to think clearly.
DT is a medical emergency that can be avoided if the proper medical treatment is administered. This needs to be established before you quit drinking. Casual drinkers may not be at risk but they may wish to consult a doctor or addiction specialist. For those who have been drinking for a long time or heavily, they should get medication to prevent DTs. It is believed that about 50% of people who are alcoholics will develop withdrawal symptoms to some degree with DT affecting 5% of those.
Randomized trials showed that benzodiazepines were more effective to prevent DTs than neuroleptics. The right electrolyte support, monitoring of vital signs, and support of the respiratory system reduces the mortality rate to 3% due to DT. In the medical industry, it’s been proven through studies that if a person is trying to stop drinking, they do need support. They need a reassuring environment that doesn’t cause them to become too anxious or excited. They also need to be constantly monitored for any early signs of DT.
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