Delirium tremens (DTs) is a severe disturbance of the brain caused by alcohol withdrawal.
DTs occur when a person who repeatedly drinks large amounts of alcohol suddenly stops or decreases the amount of alcohol consumed.
These factors increase your chance of developing DTs:
- History of heavy alcohol use and abuse
- History of DTs or other withdrawal symptoms
- Other medical problems in addition to alcohol use disorder
Symptoms usually begin 3-7 days after suddenly stopping or decreasing alcohol intake. Symptoms may include:
- Confusion and disorientation
- Changing levels of alertness
- Difficulty sleeping
- Bad dreams
- Severe agitation
- Hallucinations—the perception of a thing, voice, or person that is not present, both visual and auditory
- Delusions—a false belief that is strongly held
- Tremors of the hands, head, or body
- Severe sweating
- Rapid heartbeat
- Rapid breathing
In severe cases, DTs can result in death, especially if untreated.
You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis of DTs is usually based on the symptoms and signs of the disorder after stopping alcohol use.
Your bodily fluids may be tested. This can be done with blood tests.
Your brain activity may be tested. This can be done with an electroencephalogram (EEG).
Images of your internal body structures can be taken with:
Treatment can be difficult. Clearing of DTs may begin in 12-24 hours, but may take up to 2-10 days. Treatment for alcohol abuse is necessary after DTs are under control.
Talk with your doctor about the best treatment plan for you. Options may include:
DTs may be treated with:
- Benzodiazepines to ease anxiety, withdrawal symptoms, and cognitive problems
- Antiseizure medications
- Antipsychotics to manage hallucinations or other cognitive problems
- Pain relievers, such as acetaminophen
- Medications to control blood pressure and heart rate
Vitamins and Fluids
Severe, life-threatening vitamin deficiency or dehydration may accompany DTs. Treatment may include:
- IV fluids, magnesium, and glucose
- IV doses of vitamin C and B-complex vitamins, including thiamine, and folic acid
To prevent having DTs, manage how you drink alcohol. If you do drink large amounts on a regular basis, do not suddenly decrease the amount or stop drinking on your own. Rather, get advice from your doctor on the safest way to lower your intake.
National Institute on Alcohol Abuse and Alcoholism
Canadian Centre on Substance Abuse
Alcohol withdrawal syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2016. Accessed June 20, 2016.
Barrons R, Roberts N. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. J Clin Pharm Ther. 2010;35(2):153-67.
Bayard M, McIntyre J, Hill KR, Woodside J. Alcohol withdrawal syndrome. Am Fam Physician. 2004;69(6):1443-1450.
McKeon A, Frye MA, Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psych. 2008;79(8):854-862.
Last reviewed June 2016 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.