Clinical features

Delirium tremens is a severe withdrawal reaction in a patient who has drunk heavily for several years.

There may be a 24-hour prodromal period in which the patient may be apprehensive, experience mild disorientation, and may fit.

The features of delirium tremens are: (1)

• delirium:
  • often worse at night
  • disorientation in time and place
  • clouding of consciousness
  • impairment of recent memory
  • agitation
    
    
• gross tremor of the hands
  
  
• sympathetic overactivity:
  • sweating
  • raised blood pressure
  • hypertension
  • pupil dilatation
    
    
• hallucinations/pseudohallucinations:
  • often visual, also aural
  • the content is often frightening
    
    
• dehydration and disturbed blood biochemistry:
  • leucocytosis
  • raised ESR
  • poor liver function tests

The patient usually is usually much improved after 36 hr.

Note - alcohol withdrawal delirium is fatal in 15% to 20% of patients if untreated. (2) Appropriate early management reduces mortality to around 1%. (3)

Reference

1. Grover S, Ghosh A; Delirium Tremens: Assessment and Management. J Clin Exp Hepatol. 2018 Dec;8(4):460-470.
2. Bruce M, Chick J. Misuse of, and dependence on, alcohol and other drugs. In: Johnstone EC, Lawrie SM, Sharpe M, et al., eds. Companion to psychiatric studies. 8th ed. London, UL: Churchill Livingstone; 2010:353-89.
3. Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014 Nov 27;371(22):2109-13.