Delirium tremens (DT) is one potential side effect of alcohol withdrawal syndrome (AWS). DT is a potentially life threatening condition that can cause tremors, hallucinations, and seizures.

AWS is a collection of symptoms a person may experience if they suddenly reduce or stop drinking after prolonged heavy alcohol use.

People who develop DT as a result of AWS require emergency medical treatment to prevent complications, including death.

This article overviews AWS and DT, including the causes and symptoms. It also provides information on diagnosing, treating, and preventing DT, and outlines the possible complications of the condition.

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AWS occurs when a person suddenly reduces or stops drinking after a long period of heavy alcohol use.

Alcohol is a central nervous system (CNS) depressant. It slows activity in the brain and other parts of the CNS. With prolonged heavy alcohol use, the brain becomes accustomed to the depressant effects of alcohol.

Consequently, if a person suddenly reduces their alcohol intake or stops drinking altogether, their CNS becomes overactive. This can trigger AWS symptoms, such as:

Without treatment, AWS can progress to a severe and potentially life threatening condition called delirium tremens (DT). This condition may cause hallucinations, seizures, and death.

AWS and DT are signs a person developed severe alcohol use disorder (AUD).

Learn more about alcohol withdrawal syndrome.

The symptoms of DT may occur as early as 48 hours after a person stops drinking alcohol.

Possible signs and symptoms of DT include:

  • visual hallucinations
  • profound confusion or disorientation
  • uncontrollable restless behavior or agitation
  • rapid heart rate
  • breathing difficulties
  • high blood pressure
  • hyperthermia
  • excessive or abnormal sweating

DT is one of the latter stages of AWS. The timeline of events leading up to DT is as follows:

  • As early as 6 hours after alcohol cessation: A person may experience minor withdrawal symptoms, such as:
    • tremor, which is usually the first symptom of AWS
    • anxiety
    • palpitations
    • gastrointestinal symptoms
    • headache
    • insomnia
  • 12 hours after alcohol cessation: Within 12–24 hours, mild withdrawal symptoms may progress to moderate symptoms. These may include hallucinations and seizures. Around 50% of people who experience withdrawal seizures also develop DT.

Without treatment, the above symptoms may progress to DT. According to a 2018 review, DT typically develops within 48–72 hours of alcohol cessation.

For a doctor to diagnose DT, there must be clear evidence of recent alcohol cessation or a reduction in alcohol consumption following prolonged or repeated heavy alcohol use.

A diagnosis involves gathering a medical history, carrying out a physical examination, and conducting lab tests.

Medical history

A doctor will take a detailed medical history to assess the following:

  • how much alcohol the person drinks
  • how frequently the person drinks
  • whether the person’s drinking follows a particular pattern
  • the type of alcohol the person drinks
  • whether the person has a previous history of AWS
  • whether the person has used other substances, such as benzodiazepines
  • whether the person has experienced a past or recent head injury
  • whether the person has a history of psychiatric illness

Physical examination

A doctor will perform a physical examination to check for conditions that could complicate a diagnosis of DT. These conditions may include:

Lab tests

Finally, a doctor may order lab tests to check for DT or rule out other conditions. Lab tests may include:

DT is a medical emergency. It requires immediate treatment in an inpatient or intensive care unit (ICU) setting. This allows medical professionals to monitor a person’s vital signs and administer necessary medications.

The main goals of treatment are to:

  • manage agitation
  • reduce the risk of seizures
  • reduce the risk of complications and death

A 2018 review explains that benzodiazepines are the mainstay treatment for DT. Like alcohol, benzodiazepines have a depressive effect, meaning they slow brain and bodily functions. This can help alleviate withdrawal symptoms.

Diazepam is the benzodiazepine doctors most frequently prescribe. Other options include chlordiazepoxide and lorazepam.

DT can cause severe and potentially life threatening complications, such as:

  • seizures
  • injuries resulting from seizures
  • heart arrhythmias
  • respiratory depression
  • aspiration pneumonia

Even with appropriate treatment, DT has a rate of death between 5 and 15%. Delaying treatment increases the risk of death.

According to a 2018 review, DT is an acute condition. It typically lasts 3–4 days but may continue for up to 8 days. Prolonged sleep usually occurs as the condition draws to an end.

Review authors note that around 1–4% of DT cases result in death. However, the risk of death has reduced significantly since doctors began treating DT with benzodiazepines.

Common causes of death in DT include:

  • hyperthermia
  • heart arrhythmias
  • seizure complications
  • other underlying medical conditions

Today, healthcare professionals routinely screen for alcohol use in hospital and primary care settings. Screening can make people more aware of their alcohol intake. In turn, this can help reduce heavy alcohol consumption.

The 2022–2025 Dietary Guidelines for Americans recommends that male adults drink no more than 2 alcoholic drinks per day and that female adults drink no more than 1 alcoholic drink per day.

However, the guidelines also state that people who do not currently drink are not encouraged to begin drinking alcohol.

The Centers for Disease Control and Prevention (CDC) provides an online tool to help people check their drinking habits and develop healthier choices.

People concerned about their drinking can talk with a healthcare professional for further advice and guidance.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) also provides tips on how to seek support for AUD. The NIAAA recommends the following:

AWS occurs when a person suddenly reduces or stops drinking after a long period of heavy alcohol use.

DT is the most severe stage of AWS. A person may experience extreme agitation, hallucinations, and seizures.

DT is a medical emergency. Without prompt treatment, the condition can result in severe complications, including death. Benzodiazepines are the standard of treatment for DT.

Anyone concerned about their alcohol consumption can speak with a healthcare professional for further advice and treatment. A person can also join an in-person or online support group. With support, it is possible to stop drinking and improve overall health and well-being.