Delirium Tremens: Symptoms, Duration, Prevention & Treatment

What Is Delirium Tremens (DTs)?

Delirium tremens is a dangerous symptom of severe alcohol withdrawal and are characterized by confusion, delusion, and hallucinations.

Alcohol is a powerfully addictive drug, and an estimated 15.1 million Americans live with an alcohol use disorder (AUD). When people with AUD abruptly stop drinking alcohol, symptoms of alcohol withdrawal typically begin to appear within 6 hours. Even mild to moderate AUD withdrawal symptoms can be incredibly uncomfortable and potentially dangerous, and severe withdrawal symptoms can be fatal.

The term “delirium tremens” was first introduced by the British physician Thomas Sutton in 1813 to describe symptoms of alcohol-induced delirium. It wasn’t until a landmark study carried out in 1955 that DTs and seizures (“rum fits”) were conclusively linked to alcohol withdrawal rather than intoxication.

Delirium Tremens Statistics

Among the most dangerous symptoms of severe alcohol withdrawal is delirium tremens (DTs), which affect approximately 3-5% of people who experience alcohol detox and withdrawal. Withdrawal delirium is a true medical emergency, with some estimates of the mortality rate of appropriately treated DTs being between 5-15%, and untreated DTs cases being as high as 37%.

Related Topic: Alcohol Withdrawal

Delirium Tremens Symptoms

Common symptoms of AUD withdrawal are fairly predictable, appearing about 6 hours after the last drink. Mild withdrawal symptoms include:

• Nausea,
• Anxiety,
• Tremors,
• Restlessness, and
• Insomnia.

Moderate withdrawal symptoms set in within approximately 24 hours of the last drink, and include:

• Pronounced tremors,
• Profuse sweating,
• Fever,
• Rapid breathing,
• Nausea/vomiting, and
• Diarrhea. Mild to moderate withdrawal symptoms typically peak around 72 hours after the last drink and subside within seven days.

People with more pronounced AUD face an even more serious set of symptoms. In addition to the standard constellation of mild and moderate withdrawal symptoms, severe alcohol withdrawal may be associated with seizures and/or DTs.

DTs symptoms include:

• Fluctuating delirium,
• Lack of awareness,
• Disturbances of attention,
• Profound confusion,
• Complete or partial amnesia,
• Hallucinations, and
• Nightmares.

DTs generally manifest about three days after withdrawal begins and persists for two to three days. In extreme cases, DTs may persist for more than eight days.

Other complications that may be associated with withdrawal delirium include:

• Seizures,
• Respiratory depression,
• Irregular heartbeat, and
• Aspiration pneumonitis (which is caused by inhalation of stomach acid or other gastric content. This is a separate medical condition from aspiration pneumonia, which is caused by inhalation of infectious bacteria).

The cause of death in cases of alcohol-induced DTs is usually:

• Hyperthermia,
• Heart failure,
• Complications associated with seizures, or
• Concomitant medical conditions that were missed or untreated.

How to Prevent Delirium Tremens During Alcohol Withdrawal

The only reliable way to prevent DTs during alcohol withdrawal is through medically managed detox. Ideally, an accurate time frame of the last drink, withdrawal onset, and symptom development can be discerned in order to predict the progression of withdrawal symptoms. In addition, AUD patients should be screened for pre-existing conditions that may influence withdrawal, and if any are found, they should be treated.

Examples of pre-existing conditions that could be mistaken for DTs include:

• Traumatic brain injury,
• Subdural hematoma (a type of stroke), or
• Meningitis (an infection in the brain).

Delirium Tremens: Risk Factors and Causes

There is currently no reliable way to predict who will experience DTs during severe withdrawal. The most significant risk factors for DTs include:

• Prior history of alcohol-related seizures or DTs,
• A concurrent illness (e.g. hypertension, pre-existing brain dysfunction),
• Older age, and
• Electrolyte imbalance (especially low levels of thiamine or potassium).

Further, Wernicke’s encephalopathy is an alcohol-related condition that is caused by low levels of thiamine and may increase the risk of DTs.

Treating Delirium Tremens and Alcohol Withdrawal

The overarching goals of treatment are to control agitation and minimize the risk of seizures, injury, and death. For the safety of the patient and the medical staff, this is best done in a locked inpatient ward or ICU. Care should be taken to avoid startling or upsetting the patient, and even the simplest procedures (e.g. taking a temperature) should be explained in detail before proceeding. A “watchful and sensitive approach” is crucial for the wellbeing of the patient.

Medications for Delirium Tremens

The benzodiazepine family of sedatives is the mainstay of DT management. In addition to keeping the patient calm, benzodiazepines substantially reduce the risk of seizures. In some cases, benzodiazepine dosing can be prodigious, or extremely great in size, with examples of over 2,000 mg of diazepam being administered over the course of the first two days in some patients (the standard dose for adults is 2-10 mg per day).

Even with extremely high doses, some patients remain incredibly agitated. In this case, a barbiturate or the anesthetic propofol may be added to the benzodiazepine dose. Propofol requires mechanical breathing and may not be a viable option in some cases. In addition, patients who are experiencing severe psychosis may be administered the antipsychotic drug haloperidol, but this can increase seizure risk.

Related Topic: Ativan for alcohol withdrawal

Is Delirium Tremens Reversible?

Delirium tremens (DTs) is a severe form of alcohol withdrawal that can lead to confusion, rapid heartbeat, sweating, and even hallucinations. Fortunately, this condition is considered reversible with prompt and appropriate treatment. The path to recovery often involves a combination of medical intervention, supportive care, and abstaining from alcohol. For many individuals, this may mean hospitalization to stabilize vital signs and ensure that complications—such as seizures or severe dehydration—are managed effectively. Medications like benzodiazepines are commonly used to reduce withdrawal symptoms and lower the risk of life-threatening complications.

Beyond medical treatment, addressing the underlying alcohol dependence is crucial. Continuous support, therapy, and aftercare programs such as Alcoholics Anonymous or counseling can help individuals avoid relapse. With the right intervention and a solid support system, the debilitating effects of delirium tremens can subside, allowing the individual to regain their health and move forward with recovery.

How Long Does Delirium Tremens Last?

The duration of delirium tremens can vary from person to person, but it most commonly begins within 48 to 72 hours after the last drink. In some cases, the onset may be delayed for up to a week if a person has been consuming large quantities of alcohol over a long period. Once DTs take hold, they can last anywhere from two to three days, though more severe episodes may persist for up to a week or even longer in rare instances.

Throughout this period, a person experiencing DTs may suffer from confusion, tremors, irritability, and intense anxiety. These symptoms can rapidly escalate in severity, which is why medical supervision is strongly recommended. Early intervention and proper treatment—typically administered in a hospital or specialized treatment facility—can shorten the duration of DTs and significantly reduce the risk of serious complications.

How Much Alcohol Do I Have to Drink to Get Delirium Tremens?

Delirium tremens typically occurs in people who have consumed significant amounts of alcohol over an extended period—often years of heavy drinking. There is no exact threshold of drinks per day that guarantees DTs will develop, as individual factors such as genetics, overall health, and tolerance play a major role. Generally, DTs are more likely to occur in individuals who regularly consume high volumes of alcohol (e.g., multiple drinks daily) and suddenly stop or drastically reduce their intake.

Importantly, someone who has experienced DTs before, or who has a history of other alcohol withdrawal complications (such as seizures), is at a higher risk of developing this condition again if they resume heavy drinking. If you suspect you are at risk, it is critical to seek medical advice and consider a supervised detoxification process rather than attempting to quit alcohol on your own.

Is Delirium Tremens a Medical Emergency?

Yes—delirium tremens is considered a serious medical emergency and can be life-threatening if left untreated. The severe fluctuations in heart rate, blood pressure, and body temperature place the body under intense stress. Furthermore, hallucinations and profound confusion can pose significant risks not only to the individual but also to those around them, as judgment and self-awareness are markedly impaired.

Because of the high potential for complications—such as seizures, cardiac arrest, or respiratory failure—immediate medical attention is vital. In a hospital setting, healthcare providers can closely monitor vital signs, administer appropriate medications, manage electrolyte imbalances, and treat any co-existing medical conditions. With timely and proper care, the fatality rate associated with delirium tremens drops significantly. Seeking emergency treatment is the safest path forward and offers the best chance of a full recovery.

Finding Treatment for People with DTs

Supportive care throughout the medical management of DTs symptoms should be geared towards reorienting the patient to their surroundings and offering reassurance that they are safe and well-cared for. Vital signs must be monitored carefully, and maintaining adequate hydration is imperative. Chronic AUD is well-known to deplete thiamine (vitamin B1) in the body, so thiamine and a multivitamin are administered. In addition, electrolyte imbalances must be corrected.

When patients have recovered, it is imperative that they are offered a pathway of support that can help them overcome AUD. Before they are released from the hospital, they should be given the option to transfer directly into a quality residential rehab program. If possible, friends and family should also be present to give support and encouragement.

Alcohol use disorders are among the most prevalent substance use disorders in America. If you or someone you love is facing an alcohol use disorder, help is available. The Recovery Village Palm Beach at Baptist Health offers evidence-based rehab programs that are tailored to meet the unique needs of each client. Call us today to learn how we can help you on your path to recovery.