Delirium tremens

Delirium tremens is sometimes referred to as ‘alcohol withdrawal delirium’; this can be confusing because delirium tremens is rare; many other causes of delirium are more common in a patient withdrawing from alcohol. Delirium tremens (also known as the ‘DTs’) is the most severe manifestation of alcohol withdrawal and is characterised by gross generalised tremulousness, sweating, fluctuating levels of agitation, hallucinations (usually tactile), disorientation and impaired attention1. Low-grade fever, tachycardia and dehydration may also be present.

Delirium tremens is a medical emergency that always requires hospitalisation and, if inadequately treated, carries mortality riskMonte, 2010, mainly from heart failure.

Delirium tremens is usually identified after 48 to 72 hours of more severe alcohol withdrawal in the setting of recent acute illness or surgery. It usually occurs if withdrawal has been:

  • unrecognised (possibly ‘masked’ by other medications such as short-acting hypnotics)
  • delayed by recent general anaesthesia
  • undertreated.

The differential diagnosis of delirium tremens is hyperactive delirium of mixed aetiology.

Patients with delirium tremens need specialist treatment, and often need admission to an intensive care unit.

Note: Delirium tremens is a medical emergency requiring specialist treatment and often intensive care unit admission.
1 A patient may use the term ‘DTs’ incorrectly to describe withdrawal tremors experienced on waking (without delirium). Recognising that these are different entities is important to avoid undue alarm when assessing the risk of severe withdrawal.Return