Delirium Tremens
Delirium tremens (DTs; lit. 'mental disturbance with shaking') is a rapid onset of confusion caused by withdrawal from alcohol. DT typically occurs 48–72 hours after the last use of alcohol and symptoms last 1–8 days. Typical symptoms include nightmares, confusion, disorientation, heavy sweating, elevated heart rate, and elevated blood pressure. Visual, auditory, and tactile hallucinations are also common. DT can be fatal especially without treatment. Occasionally, a very high body temperature or seizures (colloquially known as "rum fits") may result in death. Other causes of death include respiratory failure and cardiac arrhythmias.
Delirium tremens typically occurs only in people with a high intake of alcohol for prolonged periods of time, followed by sharply reduced intake. A similar syndrome may occur with benzodiazepine and barbiturate withdrawal, however the term delirium tremens is reserved for alcohol withdrawal. In a person with delirium tremens, it is important to rule out other associated problems such as electrolyte abnormalities, pancreatitis, and alcoholic hepatitis.
Prevention is by treating withdrawal symptoms using similarly acting compounds to taper off the use of the precipitating substance in a controlled fashion. If delirium tremens occurs, aggressive treatment with benzodiazepines improves outcomes. Treatment in a quiet intensive care unit with sufficient light is often recommended to re-orient the patient. Benzodiazepines are the medication of choice with short acting compounds including lorazepam and oxazepam commonly used, which bypass the liver. These medications are typically given in response to the patient's symptoms, rather than at regular intervals. Nonbenzodiazepines are often used as adjuncts to manage the sleep disturbance associated with condition. The antipsychotic haloperidol may also be used in order to combat the overactivity and possible excitotoxicity caused by the withdrawal from a GABA-ergic substance. Antipsychotics, however, are not used alone as they may increase the risk of seizure. Thiamine (vitamin B1) is recommended to be given intramuscularly, because long-term high alcohol intake and the associated nutritional deficit leads to a thiamine deficiency, which sometimes cannot be rectified by supplement pills alone.
Mortality without treatment historically has been between 15% and 40%. With improvements in treatment over the years, currently death occurs in about 1% to 4% of cases.
About half of people with alcoholism will develop withdrawal symptoms upon reducing their use. Of these, 3% to 5% develop DTs or have seizures.
The name delirium tremens was first used in 1813; however, the symptoms were well described since the 1700s. The word "delirium" is Latin for "going off the furrow", a plowing metaphor for disordered thinking. It is also called the shaking frenzy and Saunders-Sutton syndrome. There are numerous nicknames for the condition, including "the DTs" and "seeing pink elephants".
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- 2014-04-11T00:00:00.000000Z
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