Delirium tremens history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

The hallmark of delirium tremens is tremor, confusion, disorientation, agitation, signs of severe autonomic instability (fever, tachycardia, hypertension) with a positive history of alcohol cessation 48 – 72hrs prior in a patients with history of chronic alcohol abuse.

• The hallmark of delirium tremens is tremor, confusion, disorientation, agitation, signs of severe autonomic instability (fever, tachycardia, hypertension) with a positive history of alcohol cessation 48 – 72hrs prior in a patients with history of chronic alcohol abuse.

Patients with delirium tremens may have a positive history of:

• Chronic heavy use of alcohol
• No alcohol consumption in last 48-72 hours in a heavy drinker
• Previous alcohol withdrawal
• Substance abuse (e.g. benzodiazepines)

Common symptoms of delirium tremens include:

• Tremor
• Hallucinations
• Agitation
• Confusion
• Disorientation

Less common symptoms of delirium tremens include

• Anxiety
• Panic attacks
• Paranoia

Other common symptoms include intense hallucinations such as visions of insects, snakes or rats (or stereotypically, pink elephants or tiny figures). These may be related to the environment, e.g., patterns on wallpaper that the patient would perceive as giant spiders attacking him or her. Unlike hallucinations associated with schizophrenia, delirium tremens hallucinations are primarily visual, but associated with tactile hallucinations such as sensations of something crawling on the subject - a phenomenon known as formication. Delirium tremens can sometimes be associated with severe, uncontrollable tremors of the extremities and secondary symptoms such as anxiety, panic attacks and paranoia. 

Delirium tremens (DT) should be distinguished from alcoholic hallucinosis, the latter occurring in approximately 20% of hospitalized alcoholics and not carrying a significant mortality. In contrast, DT occurs in 5-10% of alcohol-dependent people and carries up to 5% mortality with treatment and up to 35% mortality without treatment.^[1] DT is characterized by the presence of altered sensorium; that is, a complete hallucination without any recognition of the real world. DT has extreme autonomic hyperactivity (high pulse, blood pressure, and rate of breathing), and 35-60% of patients have a fever. Some individuals experience seizures.

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