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All You Want To Know About Delirium Tremens

One thing you must keep in mind when you consume alcohol is the side effects that follow. And the worst part is that the side effects do not end with you deciding to quit alcohol. Unfortunately, alcohol, like any other addictive substance, comes with a series of withdrawal symptoms that range from mild to severe. These withdrawal symptoms are usually both mental and physical and take a massive toll on your wellbeing in general. Technically speaking, there are several kinds of withdrawal symptoms ranging from anxiety and paranoia to seizures; in some extreme cases, it might even lead to death.

The common side effects of alcohol withdrawal syndrome include anxiety, agitation, palpitation, dilated pupils, nausea and vomiting, seizures, respiratory difficulty and many others. Usually, there are three phases in which these symptoms occur. In their most extreme form, they might even prove to be fatal. This is precisely why it is recommended that you seek medical help when you decide to quit alcohol. Sudden impulses may not always be the right decision in these cases.

Delirium tremens or DTs happens to be another severe form of alcohol withdrawal syndrome. People who had been addicted to alcohol for a longer period of time than others are likely to experience delirium tremens which might even prove to be life threatening in certain cases. In the article below, we have provided a detailed study of what delirium tremens is and how it affects you.

What is delirium tremens?

Delirium tremens, in common parlance, is often referred to as “Shakes” based on its characteristics and its nature. This usually occurs when someone who had been regularly consuming alcohol for more than ten years decides to quit drinking all of a sudden. As a result, there are certain changes caused in the central nervous system; the symptoms usually start in forty eight to ninety six hours post consumption of your last drink and may last for more than a week.

Delirium tremens has been described as the most severe and lethal form of alcohol withdrawal syndrome. It is characterised by a sympathetic overdrive or autonomic hyperactivity and a global confusion or a changed mental status. This may further lead to a cardiovascular collapse. Safe to say, delirium tremens classifies as a medical emergency.

As a chronic drinker, there are several changes that take place in the neurotransmitters in your brain. For instance, alcohol increases the release of endogenous opiates. It also activates the GABA A or gamma-aminobutyric acid-A neurotransmitter. Now gradually, with the passage of time, your body becomes used to these changes. If you decide to stop drinking one fine day, your body isn’t able to figure out what to do. Your brain isn’t used to this and naturally starts acting up. When you stop drinking, the GABA A neurotransmitter production is inhibited and that results in tremors, tachycardia, diaphoresis, seizures and extreme anxiety. The massive toll on your nervous system may further lead to delirium. This is the most extreme form of DTs.

Alcohol, in short, excites your neurons. Once you stop drinking, your brain basically craves for the same feeling that you got when you drank. As a result, your body starts compensating for the lack of alcohol. If one has been through alcohol withdrawal syndrome beforehand, this increases his or her chances of suffering from delirium tremens.

There are some risk factors that you must take into account when it comes to delirium tremens:

  • If you have been through alcohol withdrawal syndrome before
  • History of delirium tremens
  • If you have recurrent ailments and other medical complications
  • History of alcohol abuse for prolonged periods of time
  • The duration it has been since you last had alcohol
  • The severity of your symptoms
  • Prior detoxification
  • Cravings for alcoholic drinks
  • Older age
  • Hypokalemia
  • Thrombocytopenia
  • Elevated levels of homocysteine in blood
  • If you have brain lesions

Symptoms of delirium tremens

The symptoms of delirium tremens usually ranges from tremors and seizures, to sudden mood changes, altered mental status, confusion, sleeping for long periods of time at a stretch, shorter attention span, hallucinations, fatigue, restlessness, agitation et cetera. In some extreme cases, delirium tremens may lead to seizures. In these seizures, the body starts shaking and jerking violently. It usually happens a few hours after your last drink.

Other symptoms may include:

  • Body tremors
  • Alterations in mental function
  • Agitation
  •  irritability
  • Confusion
  •  disorientation
  • Shorter attention span
  • Delirium
  • Excitement
  • Fear
  • Hallucinations
  • Increased activity
  • Sudden mood changes
  • Restlessness
  • Sensitivity to sound, light and touch
  • Stupor and sleepiness
  •  fatigue

Take a look at some of the other symptoms that come along with it:

  • Anxiety
  • depression
  • Fatigue
  • Headache
  • Insomnia
  • Irritability and excitability
  • appetite loss
  • Nausea
  •  vomiting
  • Nervousness,
  •  jumpiness
  • Pale skin
  • Palpitations
  • Shakiness
  • Sweating palms and face

In some cases, these symptoms are also accompanied with chest pain, stomach pain and fever.

Complications that may arise from delirium tremens include:

  • Over sedation
  • Respiratory depression
  • respiratory arrest
  • intubation
  • Aspiration pneumonitis
  • Cardiac arrhythmias

There are some other complications that may arise due to the symptoms mentioned above. They include:

  • Injury caused due to seizures. During extreme seizures, you might even fall down and hurt yourself, since your body is not in your control and shakes involuntarily.
  • In a state of delirium and confusion, you may end up hurting yourself or those around you. This is mainly because you are not in your senses and have no idea of what you’re doing.
  • Irregular heartbeat. This is pretty serious and may prove to be fatal.
  • Seizures, which may end up being pretty violent.

Even though treatment is available for delirium tremens, the mortality rate at present is about 5 to 15 %. This is pretty good, considering that the rate was 35 % before technological advancement and intensive care management improved. In delirium tremens, patients who are suffering from fever, electrolyte and fluid imbalance, or illnesses like pneumonia, occult trauma, hepatitis, alcohol ketoacidosis, pancreatitis et cetera.

Treatment for delirium tremens

Alcohol withdrawal syndrome, no matter how severe it is, is treatable and curable. At present, there are numerous treatment methods available that you can make use of. The whole point of seeking treatment for delirium tremens is to smoothen the alcohol recovery process for the person, ensure that they sail through the journey, avoid severe complications, and reduce symptoms. In the case of delirium tremens, especially in the severe cases, hospital stay is always recommended. That way, you get to remain under medical supervision. Your fluid levels, electrolyte imbalance, and other vital signs like temperature will be closely monitored. In most cases, the patient is given some form of benzodiazepine like valium or libirum. The drugs would be calming down your nervous system and would suppress the neurotransmitters which are now working overtime. That may significantly reduce the effects of delirium tremens.

Physical examination and tests

This is something you need to understand loud and clear – delirium tremens is classified as medical emergency. This means, you must seek medical help under all circumstances. Without medical attention, it may rapidly take a turn for the worse and it might prove to be fatal. When you approach a physician, they would be carrying out a physical examination first and foremost. In the examination, they would be checking for the following symptoms or problems:

  • Heavy sweating
  • Increase in startle reflex
  • Irregular heartbeat or palpitations
  • Problems in moving the muscles of the eye
  • Rapid heart beat
  • Rapid and sudden muscle tremors

A few tests may also be carried out to test the level of alcohol in blood, fluid and electrolytes level and to assess the severity of the condition. Based on the results obtained, you will be diagnosed and a course of treatment will be determined for you.

 

The tests commonly carried out include:

  • magnesium level in blood
  • phosphate level in blood
  • Comprehensive metabolic panel
  • Electrocardiogram
  • Electroencephalogram
  • Toxicology screen

There are some ailments that are commonly associated with alcohol withdrawal syndrome and delirium tremens. While under medical supervision, the doctors would be keeping an eye out for the following complications:

  • Alcoholic cardiomyopathy
  • Liver disease caused due to alcohol
  • Alcoholic neuropathy
  • Wernicke-Korsakoff syndrome

In short, while the person is under medical supervision at the hospital, he or she will receive treatment which helps one stay relaxed and preferably sedated till the worst is over. This helps reduce the effects of delirium tremens. Seizures, tremors and anxiety are pretty common in delirium tremens. The sedation and drugs will help control the above and keep a check on them. Mental disorders are a common side effect of alcohol withdrawal syndrome. If you are diagnosed with any mental disorder once you quit drinking, you will be receiving treatment for that too.

However, the treatment or recovery process doesn’t end there. The above mentioned treatment methods will only provide short term relief. For a long term effect, there are some other things that must be done.  These include:

  • There has to be a kind of drying out period. This is done basically to get rid of any alcoholic trace in your body. By the end of this period, your body will be completely alcohol free and you will undergo detoxification.
  • Delirium tremens and alcohol withdrawal syndrome in general must be followed by a period of abstinence. During this period, you are forbidden from touching alcohol in any form.
  • Counselling is a must. Alcohol recovery is tough, as anyone who has been through it would tell you. It is almost impossible to reach the finish line without support. Adequate support may be provided by a counsellor who knows exactly what you are going through. A counsellor would help you keep up your sobriety and would help you make the lifestyle modifications that are important.
  • Support groups are of immense help. These groups are created by a bunch who have embarked on a similar journey as you; it may help to learn about the stories of people who have walked a similar path and live to tell the tale. It would motivate and inspire you to keep going even when you think you can’t.

Prognosis

What you must remember is that delirium tremens is a serious ailment, and may often have side effects that linger for a year or two. Yes, you heard that right. The effects may hang around long after the problem disappears. If you or a loved one is suffering from delirium tremens, then you must prepare yourself for the following:

  • Sudden mood swings which are completely erratic
  • Fatigue and tiredness. You may end up feeling way too tired all the time, for no good reason.
  • Sleeplessness is common. You might suffer from insomnia for months or even years after giving up alcohol.

Prevention? Well, the only way you can prevent delirium tremens is by treating the withdrawal symptoms beforehand. When you quit alcohol, you are bound to show certain symptoms. The key is to not ignore these symptoms or treat them lightly. Even though anyone who quits alcohol is bound to face alcohol withdrawal syndrome, it rarely escalates to delirium tremens. It happens in only about 5 % of the cases, especially if the symptoms go untreated. Seeking treatment earlier on will also significantly reduce chances of complications in the future. It is recommended that you get yourself admitted into a quiet and serene intensive care unit of a specialised facility, where you may recover peacefully. Adequate care and support (both mentally and physically) is what you need at this point.

Remember, delirium tremens occurs only in the most severe of cases. Scary as it is, it might happen to any one of you. Yet, there is a way out; there is always something you can do.

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