Complicated alcohol abstinence (delirium tremens)

Alternative names:

DT's

Symptoms:

• symptoms of alcohol withdrawal
  • feeling jumpy or nervous
  • feeling shaky
  • anxiety
  • irritability or easily excited
  • emotional volatility, rapid emotional changes
  • depression
  • fatigue
  • difficulty thinking clearly
  • palpitations (sensation of feeling the heart beat)
  • headache, general, pulsating
  • sweating, especially the palms of the hands or the face
  • nausea
  • vomiting
  • loss of appetite
  • insomnia, difficulty falling asleep
  • pale skin

• mental status changes
  • mood changes rapidly
  • restlessness
  • increased activity
  • decreased attention span
  • excitement
  • fear
  • confusion, disorientation
  • agitation, irritability
  • hallucinations, visual hallucinations (snakes, bugs, etc.) are most common
  • sensory hyperacuity (highly sensitive to light, sound, touch, etc.)
  • delirium (severe, acute loss of mental functions)
  • decreased mental status
    • stuporous, somnolent, lethargic
    • deep sleep that persists for a day or longer
    • usually occurs after acute symptoms

• seizures
  • usually generalized tonic-clonic seizures
  • most common in first 24 - 48 hours
  • most common in people with previous alcohol withdrawal complications

• body tremors

Additional symptoms that may be occur:

• fever
• stomach pain
• chest pain

Note: Symptoms most commonly occur within 72 hours after the last drink but may occur up to 7 to 10 days after the last drink. Symptoms may progress rapidly.

Signs and tests:

Complicated alcohol abstinence is a medical emergency. The health care provider should be consulted promptly.

An examination of the neuromuscular system may show increased startle reflex, rapid rhythmic muscle tremor, or other changes indicating alcohol withdrawal. Evidence of increased autonomic function such as profuse sweating may be present. There may be symptoms of dehydration or malnutrition and signs indicating electrolyte disturbances. An eye inspection may show abnormalities of eye muscle movement such as lid lag. The heart rate may be rapid and there may be an irregular heart beat. The blood pressure may be normal or low.

A serum toxicology screen is usually positive for alcohol. Serum chemistry (chem-20) may show electrolyte disturbances, especially decreased levels of potassium and magnesium. An ECG (electrocardiogram) may show arrhythmias. An EEG (electroencephalogram) may be performed to rule out other causes of seizures.