Delirium tremens is an uncommon withdrawal symptom that occurs in people who are addicted to alcohol. It’s a brain disorder that causes a sudden onset of extreme confusion and disorientation. It can also lead to violent behavior. And in some cases, people with delirium tremens die if they don’t receive medical treatment. Recognizing the signs of delirium tremens is the first step in getting treatment to avoid a dangerous outcome.

If you’re trying to quit drinking, reading this article is a good place to start. You might recognize some of these signs in yourself. Or you might know someone else who is struggling with alcohol withdrawal. No matter what, you can take the first step toward getting help. Now, let’s take a closer look at this very dangerous withdrawal symptom.

What Is Delirium Tremens?

Delirium tremens is a withdrawal syndrome that can occur in people who drink heavily. It’s medically known as a “delirium tremens” because it typically involves a state of extreme confusion. It may be triggered by various things, such as fever, surgery, or a traumatic injury. But the main cause is alcohol withdrawal. Regardless of the triggers, acute episodes of DTs are usually preceded by several phases that alter brain chemistry and cause disorientation, anxiety, and confusion known as a withdrawal syndrome when not treated with medication.

According to the National Library of Medicine, several people (50% of those with a history of alcohol dependence) may experience alcohol withdrawal symptoms when stopping or reducing their alcohol consumption. However, only a few (3% to 5%) display severe alcohol withdrawal symptoms, including impaired cognition, involuntary muscle movements, and cardiac collapse. This condition is known as alcohol withdrawal delirium and is more commonly referred to as delirium tremens (DT).

Effects of Delirium Tremens

When a person stops drinking alcohol, the body has two to three days to get used to the sudden decrease in alcohol intake. If the decrease is too rapid, the person may experience symptoms of delirium tremens.

If you are a heavy drinker, chances are you have experienced some symptoms of delirium tremens. In severe cases, delirium tremens can cause seizures and hallucinations, which are common symptoms of severe withdrawal. Individuals who feel severe withdrawal symptoms may not be able to pinpoint exactly what is wrong with them. They may feel fatigued, unwell, or have strong cravings for alcohol. This can lead to paranoia and hallucinations, which can be frightening and disorienting for the person experiencing them.

The most common signs and symptoms of delirium tremens are:

  • Ataxia (incoordination)
  • Confusion
  • Hallucinations
  • Difficulty sleeping or sleeping too much
  • Muscle spasms
  • Sweating
  • Emotional lability (an intense change of mood)
  • Marked increase or decrease in body temperature

Diagnosing delirium tremens can be challenging. It’s usually diagnosed based on a person’s clinical history and a neurological exam. 

Timeline of Delirium Tremens

For those suffering from Delirium Tremens (DT), the signs usually become visible 2 to 4 days after the last time alcohol was consumed, although in some cases they may show up as late as 7 to 10 days later. DT is classified as Phase 3 of Alcohol Withdrawal Syndrome (AWS); however, not everybody will experience it.

Phase 1 – Mild Symptoms

During the first phase of alcohol detoxification, which commences 8 to 24 hours after the last alcoholic beverage, mild withdrawal symptoms may arise, including sleeplessness, headaches, and heightened unease.

Phase 2 – Moderate Symptoms

Approximately two to three days after someone has had their last alcoholic beverage, the second phase of Alcohol Withdrawal Syndrome will start to take effect. Symptoms of this phase will include sweating, feeling sick to the stomach, elevated blood pressure, and hearing or seeing hallucinations around 12 to 24 hours after the person’s final drink.

Phase 3 – Withdrawal Seizures

In extreme alcohol withdrawal cases, individuals may experience the third phase, seizures and Delirium Tremens, occurring two to four days after the last drink. These indications can last for up to five days, in which there will be a lack of consciousness, intense muscle spasms, and possibly a coma.

Risk Factors of Developing Delirium Tremens

As a person persists in drinking alcohol, the brain progressively adapts. Ultimately, the individual builds up a reliance on alcohol, which means that when alcohol intake is curtailed or drastically lowered, the brain still produces activating messages to counterbalance alcohol’s suppressive effects. This overcompensation results in an increased emphasis on activating signals and leads to a state of hyper-arousal that the person perceives as withdrawal symptoms. Certain risk factors associated with the intensity of alcohol withdrawal, such as the development of delirium tremens, include:

  • Consuming increasingly more alcohol
  • History of intense alcohol withdrawal symptoms, seizures, or Delirium Tremens
  • Health issues such as liver or kidney disease or brain damage
  • Age
  • Having a mental disorder
  • Medications being taken

Dangers of Alcohol Withdrawal

If you or someone you love is in the midst of a delirium tremens episode, call 911 immediately. This is the most dangerous part of alcohol withdrawal. The longer you go without medical care, the higher the risk of death. And the longer you’ve been drinking, the higher the risk of delirium tremens.

People who develop delirium tremens are often not in good health to start with. They’re already at a higher risk for health problems. This includes heart disease, liver and pancreatic cancer, and tuberculosis. The risk of death is highest in the first 24 hours without treatment.

Why is Delirium Tremens So Dangerous?

Like all addictions, alcohol dependence causes changes in the brain. When this happens, delirium tremens can develop. But what causes it to go from being a sign of alcohol withdrawal to a dangerous brain disorder?

One reason is that the nervous system is extremely sensitive to stress. If a person is emotionally or physically stressed, their nervous system may react to the stress by going into overdrive. This can lead to a delirium tremens episode.

Another cause is that a person’s liver is not able to break down the toxic products (byproducts) of alcohol metabolism. These products include acetone, ethylene glycol, and methanol. When they build up in the body, they can cause delirium tremens.

How to Recognize the Symptoms of Delirium Tremens

If you or someone you love exhibits any of the above symptoms, call 911 immediately. Use the following checklist to help identify the symptoms in yourself or someone else:

  • Sudden and unexpected confusion
  • Uncontrollable tremulousness or shaking
  • Unable to express or understand basic thoughts or ideas
  • Making odd noises or gestures
  • Unable to sleep or stay asleep
  • Vomiting or gassiness
  • Marked change in behavior
  • A high fever or other signs of infection
  • A change in personality or mood

How Long do Delirium Tremens Last?

Delirium tremens is not a long-term issue, however, it may be deadly. Prompt medical assistance for alcohol withdrawal signs can assist in making certain withdrawal does not get to the gravity of DTs. This problem generally persists for 3-4 days, although it can go on for up to 8 days. Nevertheless, the degree and duration of DTs will differ from person to person. Even though medical aid is essential to obtain while experiencing indications, the symptoms may still progress and become more serious after they have appeared. It is critical to understand that if you keep on drinking after you have gone through detoxification, you are more likely to experience DTs in the future.

How to Prevent Delirium Tremens

In order to stay clear of delirium tremens, people who have chosen to quit drinking should get assistance right away. Entering a dependable medical detoxification program can guarantee that a group of specialists will help prevent DT or help you deal with any signs of withdrawal. When your body has been freed from alcohol, the most ideal thing you can do is to go to a rehabilitation facility to receive professional guidance for this issue.

To steer clear of delirium tremens, it is best to not drink alcohol at all. If you do decide to drink, though, you should keep it within the limits of American dietary guidelines. According to those guidelines, males should not have more than two drinks per day, and females should not have more than one. If you consume more than those amounts, and have one or more of the risk factors for severe withdrawal (including seizures and delirium tremens), it is a good idea to talk to a doctor or seek help from a treatment facility before cutting back or quitting drinking. Early and correct treatment of alcohol withdrawal may lessen the likelihood of symptoms progressing to delirium tremens.

Delirium Tremens Treatment and Care

There is no cure for delirium tremens, but you can reduce your chances of experiencing it and alleviate symptoms if you are. If you are experiencing any of the symptoms of delirium tremens, you should seek treatment right away. In most cases, doctors treat delirium tremens with a combination of anti-anxiety medications, antipsychotics, and anticonvulsants. When given properly, these drugs can help calm your mind and reduce your fear of hallucinations.

Some people may also choose to take antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). If you suffer from DTs, it is important that you remain hydrated. It is also a good idea to eat a healthy diet, including protein and carbohydrates. If you feel like drinking again, you should not. Instead, you should seek help as soon as possible.

What Medications are Used for Delirium Tremens?

Medical assistance is strongly suggested if you are showing signs of having extreme alcohol withdrawal side effects. Delirium tremens is a critical medical condition and it is advisable to be hospitalized so that medical experts can offer drugs and constant surveillance. In extreme cases, you may need to be in an intensive care unit (ICU). Delirium tremens has life-threatening potential and the situation can rapidly deteriorate. Medications that are used to manage delirium tremens include:


Benzodiazepines, like lorazepam (Ativan), diazepam (Valium), or chlordiazepoxide (Librium), are usually prescribed to treat the majority of alcohol withdrawal symptoms including delirium tremens and to avoid the occurrence of seizures. These drugs are the most frequently used and large doses may be required.


Antipsychotic medicines like Haldol are sometimes prescribed in small amounts to manage issues like agitation and auditory illusions, and improve thought processes, even though they have been linked to unfavorable consequences.


In cases where benzodiazepines have been unable to adequately treat a condition, barbiturates such as phenobarbital are sometimes prescribed as an additional medication.

In Conclusion

Delirium tremens (DTs) is a powerful and dangerous withdrawal syndrome that affects alcohol abusers in the advanced stages of their addiction. DTs often occurs after weeks or months of heavy drinking when someone becomes dependent upon their daily intake of alcohol and builds up tolerance over time. This painful condition will take a tough toll on your body and mind. 

If you keep drinking excessively beyond reasonable limits or start using alcohol out of habit rather than necessity, then you might already have some symptoms of dependence upon substances and could potentially be exposed to an onset of Delirium Tremens, depending on your intake amount. 

Get Help if You Have the Symptoms of Delirium Tremens

Alcohol withdrawal is a tough journey. You might not be able to finish it on your own. If you or someone you love is experiencing the symptoms of delirium tremens, call 911 immediately. You should also call your doctor, because this could be a sign of a medical emergency. In some cases, people need hospitalization. They might need to be placed on a ventilator (inhaler) to assist them with breathing. 

It’s also a good idea to get yourself to the hospital if you are vomiting or unable to wake up. Keep in mind that delirium tremens can be a scary, unpredictable, and dangerous condition. You should seek help immediately if you think you or someone else is experiencing these symptoms.

Knoxville Recovery Is Here For You

Excessive alcohol use can lead to a dangerous condition called delirium tremens. This syndrome can develop if a person goes through alcohol withdrawal. Addiction can affect anyone. If you or a loved one are currently struggling with alcoholism, help is available! We encourage you to reach out to the professionals at Knoxville Recovery Center to learn more about our personalized treatment programs and mental health services. 

Knoxville Recovery Center was founded from firsthand experience of addiction and recovery, with a mission of providing a space where people can heal from addiction and other disorders in a compassionate, creative, open-minded, and heart-centered environment. We believe recovery is always possible. Our experts work with you to design a treatment plan that fits your needs. Common treatment programs include:

  • Intensive Outpatient Programs (IOP)
  • On-site Detox
  • Full-time Addiction Treatment on campus
  • Mental Health Treatment
  • Aftercare Services

Contact us today for more information about how our programs and services can help you get your life back on track. You no longer have to struggle with alcoholism on your own. We are here to help. 

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