Introduction
Delirium tremens is a delirium brought on by the withdrawal of alcohol in a person who has been a chronic alcoholic.
This is a psychiatric emergency, which usually starts 48 to 72 hours after alcohol withdrawal, but can be delayed up to 7 days.
Symptoms of delirium tremens
The patient is getting very anxious and suffers from mental confusion.
Patients have poor sleep and awake from dreams and nightmare. There is profuse sweating, an unexplained fever and a fast heart beat. The delirium tremens sets in with hallucinations of little animals crawling over the bed, hallucinations that the patient would be chased. It is so real to the patient that it may be extremely frightening and possibly cause irrational flight attempts.
The patient experiences disturbances of the balance organ, which translate subjectively into feelings of falling walls, a moving floor or the room turning around. At the same time there are muscle tremors (“tremens”=Latin for “with tremor”), which are coarse in nature and start typically at the hands, then travel up the arms and possibly to the head and trunk. There can also be an ataxic gait (uncoordinated gait with legs wide apart).The patient may rip an intravenous line or a bladder catheter out and attack the nurses believing that they want to harm him/her.
Diagnosis
The diagnosis is made based on experience, based on the history of alcohol withdrawal and supported by the observation of the clinical situation and the symptoms.
Delirium Tremens
Treatment
This condition should be treated in an Intensive Care Unit setting. Treatment is too specific to delineate here in detail. Briefly, rehydration with intravenous fluids and nutritional supplement vitamin (Vitamin C, B-complex, thiamine, B12 and folic acid) is given. To treat the agitation, benzodiazepines such as diazepam, chlordiazepoxide or lorazepam are used. For extreme hallucinations antipsychotics have to be added for a period of time. In the meantime specially trained nurses who have experience in treating these type of patients will be able to quickly calm the patient down in a quiet side room of the Intensive Care Unit. After 12 to 24 hours the patient usually enters into a deep sleep, from which the patient awakes mostly with a clear mind.
It is important to analyze the social situation at home and a social worker should follow this up on an outpatient basis later. The patient should participate voluntarily in Alcoholic Anonymous meetings to keep sobriety. Sometimes patients want a chemical assurance that they will stay sober. The physician can then decide to put the patient on disulfiram (brand name: Antabuse), which is a chemical substance that changes the metabolism of alcohol. Should the patient drink alcohol while on Antabuse, there would be facial flushing, severe abdominal pain and vomiting, which would then reinforce physically to the patient that alcohol is off limits and reinforce abstinence from alcohol. It is safe to take Antabuse for years.
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