Global InformationDelirium tremens information
| Delirium tremens | |
|---|---|
 | |
| An alcoholic man with delirium tremens on his deathbed, surrounded by his concerned family. The text L'alcool Tue means "Alcohol Kills" in French. | |
| Specialty | Psychiatry, critical care medicine |
| Symptoms | Alcoholic hallucinosis, confusion, shaking, shivering, irregular heart rate, sweating[1][2] |
| Complications | Very high body temperature, seizures[2] |
| Usual onset | Rapid[2] |
| Duration | 2–3 days[2] |
| Causes | Abrupt cessation of alcohol intake in a state of alcohol dependence |
| Differential diagnosis | Benzodiazepine withdrawal syndrome, barbiturate withdrawal[3] |
| Treatment | Intensive care unit, benzodiazepines, thiamine[2] |
| Prognosis | Risk of death ~2% (treatment), 25% (no treatment)[4] |
| Frequency | ~4% of those withdrawing from alcohol[2] |
Delirium tremens (DTs; lit. 'shaking frenzy') is a rapid onset of confusion usually caused by withdrawal from alcohol.[2] When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days.[2] Physical effects may include shaking, shivering, irregular heart rate, and sweating.[1] People may also hallucinate.[2] Occasionally, a very high body temperature or seizures (colloquially known as "rum fits")[5][6] may result in death.[2] Alcohol is one of the more dangerous drugs to withdraw from.[7]
Delirium tremens typically occurs only in people with a high intake of alcohol for more than a month.[8] A similar syndrome may occur with benzodiazepine and barbiturate withdrawal.[3] Withdrawal from stimulants, such as cocaine and amphetamines, does not have major medical complications.[9] In a person with delirium tremens it is important to rule out other associated problems such as electrolyte abnormalities, pancreatitis, and alcoholic hepatitis.[2]
Prevention is by treating withdrawal symptoms using similarly acting compounds to taper off the use of the precipitating substance in a controlled fashion.[2] If delirium tremens occurs, aggressive treatment improves outcomes.[2] Treatment in a quiet intensive care unit with sufficient light is often recommended.[2] Benzodiazepines are the medication of choice with diazepam, lorazepam, chlordiazepoxide, and oxazepam all commonly used.[8] They should be given until a person is lightly sleeping.[2] Non-benzodiazepines are often used as adjuncts to manage the sleep disturbance associated with condition. The antipsychotic haloperidol may also be used,[2] as a major tranquilizer, in order to combat the overactivity and possible excitotoxicity caused by the withdrawal from a GABA-ergic sedative. The vitamin thiamine is recommended to be given intramuscularly,[2] because long term high alcohol intake and the often attendant nutritional deficit damages the small intestine, and so leads to a thiamine deficiency which sometimes cannot be rectified by supplement pills alone.
Mortality without treatment is between 15% and 40%.[4] Currently death occurs in about 1% to 4% of cases.[2]
About half of people with alcoholism will develop withdrawal symptoms upon reducing their use.[2] Of these, 3% to 5% develop DTs or have seizures.[2]
The name delirium tremens was first used in 1813; however, the symptoms were well described since the 1700s.[8] The word "delirium" is Latin for "going off the furrow," a plowing metaphor.[4] It is also called the shaking frenzy and Saunders-Sutton syndrome.[4] There are numerous nicknames for the condition, including "the DTs" and "seeing pink elephants".
- ^ a b Healy, David (3 December 2008). Psychiatric Drugs Explained. Elsevier Health Sciences. p. 237. ISBN 978-0-7020-2997-4. Archived from the original on 8 September 2017.
- ^ a b c d e f g h i j k l m n o p q r s t Schuckit, MA (27 November 2014). "Recognition and management of withdrawal delirium (delirium tremens)". The New England Journal of Medicine. 371 (22): 2109–13. doi:10.1056/NEJMra1407298. PMID 25427113. S2CID 205116954.
- ^ a b Posner, Jerome B. (2007). Plum and Posner's Diagnosis of Stupor and Coma (4 ed.). Oxford: Oxford University Press, USA. p. 283. ISBN 9780198043362. Archived from the original on 2016-03-04.
- ^ a b c d Blom, Jan Dirk (2010). A dictionary of hallucinations (. ed.). New York: Springer. p. 136. ISBN 9781441912237. Archived from the original on 2016-03-04.
- ^ "rum fits". Medical dictionary. Farlex, Inc. Retrieved 22 November 2022.
- ^ Rhinehart, John W. (1961). "Factors determining "rum fits"". American Journal of Psychiatry. 118 (3): 251–252. doi:10.1176/ajp.118.3.251. ISSN 0002-953X. PMID 13741146. Retrieved 1 February 2023.
- ^ Fisher, Gary L. (2009). Encyclopedia of substance abuse prevention, treatment, & recovery. Los Angeles: SAGE. p. 1005. ISBN 9781452266015. Archived from the original on 2015-12-22.
- ^ a b c Stern, TA; Gross, AF; Stern, TW; Nejad, SH; Maldonado, JR (2010). "Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles"". Primary Care Companion to the Journal of Clinical Psychiatry. 12 (3). doi:10.4088/PCC.10r00991ecr. PMC 2947546. PMID 20944765.
- ^ Galanter, Marc; Kleber, Herbert D (1 July 2008). The American Psychiatric Publishing Textbook of Substance Abuse Treatment (4th ed.). United States of America: American Psychiatric Publishing Inc. p. 58. ISBN 978-1-58562-276-4. Archived from the original on 4 March 2016.