Delirium Tremens
Delirium tremens is the most severe symptom of alcohol withdrawal. It begins about 2-3 days after a person who is dependent on alcohol stops drinking. Delirium tremens symptoms can last for 2-3 days and can even last for a week.
A person experiencing delirium tremens may experience changes in mental status (becoming very confused) and become very hyperactive. If left untreated, delirium tremens can lead to heart attack, stroke, and death.
Symptoms of Delirium Tremens
In general, delirium tremens symptoms appear 2-4 days after the last drink. However, some symptoms may not appear until 10 days after a person stops drinking alcohol. Signs and symptoms of delirium tremens include several symptoms, namely:
- Minor alcohol withdrawal;
- Tremors;
- Anxiety;
- Nauseous;
- Vomit;
- Insomnia.
- Major alcohol withdrawal;
- Visual hallucinations;
- Auditory hallucinations;
- Tremors throughout the body;
- Vomit;
- Diaphoresis;
- Hypertension.
- Withdrawal causing seizures;
- Agitation, restlessness, tumult;
- Confusion;
- Disorientation;
- Hallucinations;
- Fever;
- Hypertension;
- Diaphoresis;
- Autonomic hyperactivity (rapid heart rate and very high blood pressure).
Risk Factors for Delirium Tremens
The risk of delirium tremens increases when a person regularly consumes large amounts of alcohol. Other risk factors include:
- Seizures due to previous alcohol withdrawal;
- Previous history of delirium tremens;
- Other medical comorbidities;
- Heavy and prolonged daily alcohol consumption;
- Previous detoxification;
- Strong desire for alcohol;
- Older age;
- Hypokalemia;
- Thrombocytopenia;
- Increased levels of homocysteine in the blood;
- The presence of structural brain lesions.
Causes of Delirium Tremens
Alcohol is a depressant because it slows down the brain and nervous system. When someone suddenly stops drinking after a long period of alcohol use, the brain and nervous system are unable to adjust quickly. Eventually, the brain becomes overstimulated.
This sudden cessation results in a functional decrease in the neurotransmitter GABA.
This results in loss of control over inhibitory neurotransmitters such as norepinephrine, glutamate, and dopamine.
A person who suddenly stops drinking can also experience a spike in an amino acid called glutamate, causing symptoms of delirium tremens.
Diagnosis of Delirium Tremens
Before diagnosing delirium tremens, a doctor will first need to perform a physical exam and medical history. The doctor may also administer a questionnaire to help determine symptoms and measure the severity of withdrawal symptoms. A score of 15 or higher can be a high risk for delirium tremens.
Cerebrospinal fluid analysis and brain imaging can also be done to assess the severity of delirium tremens symptoms. In addition, the following supporting examinations can be done to confirm the diagnosis, including:
- Blood sugar check;
- Blood tests to check for use of certain drugs;
- CT scan of the head, to see if there is any brain damage caused by alcohol;
- Lumbar puncture, to look at brain fluid (cerebrospinal fluid, CSF) to see if alcohol is affecting seizures or other conditions that occur after alcohol withdrawal.
Doctors may also examine the liver, heart, nerves and digestive system to determine the extent of alcohol damage to the body. People with delirium tremens may also have vitamin deficiencies due to unhealthy diets.
Delirium Tremens Complications
Complications of delirium tremens include the following:
- Excessive sedation, excessive desire to sleep;
- Respiratory depression and respiratory arrest;
- Aspiration pneumonitis;
- Cardiac arrhythmia, a condition of irregular heartbeat.
Delirium Tremens Treatment
Delirium tremens cannot be treated with home remedies and needs to be treated in a hospital. Some treatment options that can be done include:
- Supportive therapy: An important component of the treatment of alcohol withdrawal syndrome and delirium tremens. This includes providing a calm environment, ongoing reassessment, attention to fluid and electrolyte deficits; and treatment of coexisting substance addictions.
- Thiamine: Thiamine may be useful in preventing confusion, ataxia, ophthalmoplegia (Wernicke’s encephalopathy) and Wernicke-Korsakoff syndrome.
- Magnesium: often given to people with a history of alcoholism, because this group is susceptible to magnesium deficiency. In addition, magnesium can also overcome severe tremors.
- Benzodiazepines: Used in patients with severe delirium tremens requiring sedation in the ICU.
People with delirium tremens may need to stay in the hospital for at least a week until their health condition is completely stable.
After that, the sufferer needs to get treatment for alcohol dependence.
Cognitive behavioral therapy (CBT) or recovery support groups are often recommended in the treatment of alcohol dependence.
Delirium Tremens Prevention
The only effective preventive measure for delirium tremens is to prevent excessive alcohol consumption. Here are some things you can do to prevent dementia tremens, namely:
- For those who are addicted to alcohol, counseling with a psychiatrist or psychologist can help reduce dependence on alcohol.
- For those who are not addicted to alcohol, you can reduce your alcohol intake.
- Always check your condition regularly, remembering that there are many problems that lurk in alcoholics.
When to See a Doctor?
If symptoms of restlessness, decreased consciousness, agitation, or even seizures are found after stopping alcohol for a certain period of time in people with a history of alcoholism, immediately seek help for further treatment.