Delirium Tremens

"Alcohol use disorder (AUD) causes substantial morbidity and mortality [1, 2]. Among AUD patients, approximately half experience major withdrawal symptoms when tapering alcohol consumption. Delirium tremens (DT) is the most severe form of alcohol withdrawal; potentially life-threatening and particularly resource-demanding [3]. DT occurs in a small proportion of AUD patients, ranging from 3 to 15% [1, 4-7], although higher prevalence has been observed [8].

"DT develops after sudden cessation or reduction of heavy and prolonged drinking, most often 2–4 days after last alcohol intake [4]. The condition is characterized by a state of confusion and autonomous hyperactivity. Impairment of cognitive function, attention, memory and/or consciousness is often seen. Many DT patients experience hallucinations—most often visual, although they may be tactile or auditory. There is often psychomotor agitation and disturbed sleep. Other clinical features include tachycardia and hypertension, increased sweating and fever, but also anxiety [9].

"The natural course of DT will usually run to 3–4 days but may last up to 8 days, most often ending with a period of prolonged sleep. Untreated in this phase, DT has a high mortality, perhaps up to 35% [10]. Treated correctly, mortality can be significantly reduced [11]. Correct treatment usually involves hospitalization, and the goal of the treatment is to control agitation and decrease the risk of seizures, injury and death [7]. The condition should be monitored during treatment in hospital using a validated and clinically useful scoring instrument, such as the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A) [4, 12]."