Delirium Tremens: Clinical Significance and Management
Delirium tremens (DTs) is a life-threatening neurological condition caused by excessive alcohol consumption. It is characterized by mental confusion, disorientation, agitation, tremors, and visual and auditory hallucinations. The condition is most commonly seen in individuals with chronic alcohol use disorder (AUD) and is associated with a high risk of mortality. This article provides an overview of DTs, focusing on epidemiology, clinical features, pathophysiology, diagnosis, and management.
Epidemiology
Alcohol misuse is the most common risk factor for developing DTs, and it is estimated that up to 6% of individuals with AUD will experience DTs in their lifetime. Studies have shown that men are more likely to develop DTs than women, with the highest incidence seen in individuals aged 45-64 years. Recent research has also shown that the prevalence of DTs is increasing in younger individuals (ages 18-24).
Clinical Features
The clinical features of DTs include mental confusion, disorientation, agitation, tremors, and visual and auditory hallucinations. Other signs and symptoms may include hypertension, tachycardia, diaphoresis, fever, and seizures. The onset of symptoms typically occurs 48-72 hours after the patient has ceased drinking and is typically at its worst on the third or fourth day.
Pathophysiology
DTs is believed to be caused by a combination of alcohol withdrawal and other factors. Alcohol withdrawal is associated with an increase in the neurotransmitter gamma-aminobutyric acid (GABA) and a decrease in the neurotransmitter glutamate. This leads to increased excitation in the central nervous system (CNS), which can result in confusion, disorientation, and agitation. Other factors such as electrolyte imbalances, alcohol-induced nutrient deficiencies, and drugs of abuse can also contribute to the development of DTs.
Diagnosis
The diagnosis of DTs is based on the patient’s history, physical examination, and laboratory tests. The patient’s history should include questions about alcohol consumption, drug use, and any other medical conditions. The physical examination should focus on the patient’s vital signs, mental status, and neurological examination. In addition, laboratory tests such as a complete blood count (CBC), electrolyte panel, and liver function tests (LFTs) should be performed.
Management
The primary goal of treatment is to prevent or reverse the symptoms of DTs. This includes implementation of non-pharmacological measures such as rest, hydration, and nutrition. Benzodiazepines are the mainstay of pharmacological treatment and are used to reduce the patient’s anxiety, agitation, and tremors. Other medications may be used to control seizures, hypertension, and other related symptoms.
Conclusion
DTs is a serious and potentially life-threatening condition caused by excessive alcohol consumption. It is characterized by mental confusion, disorientation, agitation, tremors, and visual and auditory hallucinations. The diagnosis is based on the patient’s history, physical examination, and laboratory tests. The treatment of DTs includes non-pharmacological and pharmacological measures and should be initiated as soon as possible to reduce the risk of complications.
References
Cox, B. M., & Zuckerman, B. (2016). Alcohol withdrawal delirium (delirium tremens). In T. A. Widiger (Ed.), Encyclopedia of psychology and law (pp. 50–53). Thousand Oaks, CA: Sage.
Jain, S., & Akhtar, S. (2020). Delirium Tremens: An Overview. Journal of Clinical and Diagnostic Research, 14(4), RD01–RD03. https://doi.org/10.7860/JCDR/2020/43986.13361
McGovern, M. P., & Bostwick, J. M. (2015). Alcohol withdrawal delirium (delirium tremens). In V. R. Preedy (Ed.), The encyclopedia of alcohol and alcoholism (pp. 1–7). Hoboken, NJ: Wiley-Blackwell.
Thomas, M., & Minson, C. T. (2019). Alcohol withdrawal syndrome and delirium tremens. In C. T. Minson, C. B. Sledge, & H. J. C. Yeh (Eds.), Neurocritical care of the older adult (pp. 51–63). Cambridge, UK: Cambridge University Press.