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Delirium Tremens: A Severe Form of Alcohol Withdrawal

Delirium tremens (DTs) is a potentially fatal condition that can occur when people stop drinking alcohol abruptly or drastically reduce how much they drink after years of consuming excessive amounts of alcohol.[1]

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Although each person’s experience may be different, most people experience delirium tremens within 48 to 96 hours after their last drink. Some people have a rapid onset of symptoms that includes a combination of intense neurological and psychotic symptoms, such as trembling, hallucinations, confusion, disorientation, and restlessness.[1]

Immediate medical attention is crucial for managing DTs. Close monitoring, medication, restoring fluid and electrolyte balance, and providing supportive care are necessary to ensure safety.[2] 

Key Facts About Delirium Tremens

Key Facts

  • Delirium tremens may occur 48 hours after a sudden cessation of heavy drinking in those with a chronic alcohol abuse history. It usually lasts for up to five days, and it comes with many challenging symptoms that can be life-threatening.[1] 
  • An estimated 1.8% of people with alcohol use disorder (AUD) will develop DTs.[2]
  • Many factors can increase the risk of experiencing delirium tremens, such as acute medical conditions, heavy alcohol intake, a history of delirium tremens, advanced age, liver dysfunction, and severe withdrawal syndrome.[3]
  • Delirium tremens can be deadly without prompt and appropriate medical attention. The mortality rate of DTs can reach up to 37%, with the highest rates among people who try to go through the process unsupervised.[1]

What Are the Causes of Delirium Tremens?

When AUD is present, delirium tremens is caused by the abrupt cessation of drinking. Over time, the body adjusts its function to include the presence of alcohol, and when that alcohol is taken away, hyperexcitability occurs in the central nervous system, causing it to go off balance.[4]

There are other potential causes of DTs, so it does not necessarily always start with an intentional cessation of alcohol use. DTs may be due to inadequate food intake as well as more overt factors, such as head injury, infection, or illness. However, the conditions only occur in those who also have a physical and psychological dependence on alcohol.[2] 

Drinking Timeline for Delirium Tremens

In most cases, delirium tremens will first appear between 48 and 96 hours following the last drink.[1] The condition can last a week or even longer, depending on individual circumstances.

DTs is an alcohol withdrawal condition that primarily affects those who have a high-dose AUD. It is more common in individuals who consume up to four pints of wine daily, seven to eight pints of beer (3.3 to 38 liters), or a half-liter of hard liquor every day for several months. It is also more common in people who have consumed alcohol for more than 10 years.[5]

Understanding the Signs & Symptoms of Delirium Tremens

If you have AUD, don’t attempt to suddenly stop drinking on your own. You need medical supervision and support to ensure you stay safe due to the risk of DTs.[1]

Some of the key indicators that delirium tremens has started include the following:[1,2,6]

  • Severe confusion, which may appear as trouble concentrating, a lapse in memory, and difficulty thinking clearly
  • Agitation and restlessness 
  • Visual hallucinations and a distorted perception of reality, affect one’s response to people and situations
  • Tremors or shaking in the hands, which is usually severe enough to interfere with the ability to do anything with the hands
  • Physical manifestations of agitation, including an increased heart rate, excessive sweating, and heart palpitations
  • Changes in blood pressure, either high or low 

Stages of Delirium Tremens 

While there will be individual variations, if delirium tremens begins, it generally unfolds along a relatively uniform timeline. Here’s what to expect:[1,2]

Initial Withdrawal Symptoms

  • Time frame: This stage begins within 6 to 48 hours after the last drink.
  • Symptoms: Restlessness, anxiety, irritability, tremors, sweating, rapid heartbeat, nausea, and insomnia characterize the initial withdrawal period.

Acute Withdrawal Phase

  • Time frame: This stage typically starts between 48 and 72 hours after the last drink and continues for up to five days.
  • Symptoms: Withdrawal symptoms increase during this phase. They may include intense confusion, disorientation, agitation, hallucinations (auditory, visual, or tactile), extreme sensitivity to light and sound, severe tremors, elevated heart rate and blood pressure, fever, sweating, and dehydration.

Peak Delirium Tremens

  • Time frame: This stage usually occurs within two to five days after the last drink, but it can take up to 10 days to get started for some people.
  • Symptoms: During this stage, the symptoms of delirium tremens peak and cause people to experience severe confusion, disorientation, vivid and frightening hallucinations, severe tremors, extreme agitation, severe sensitivity to light and sound, increased heart rate and blood pressure, fever, profuse sweating, dehydration, and possible seizures.

Subsiding Symptoms

  • Time frame: This stage generally begins within five to seven days after the onset of delirium tremens.
  • Symptoms: In this final stage of delirium tremens, symptoms gradually decrease in intensity, but hallucinations, confusion, and tremors may still occur. Fatigue and irritability may persist for weeks or even months.

How Long Does Delirium Tremens Last? 

Delirium tremens is a serious medical condition that requires immediate medical attention. The disorder generally lasts between five days, although it can be shorter or longer. For as long as it lasts, it is a medical crisis.[7] 

Should I Rush to the Emergency Room?

Yes, if you suspect DTs, seek emergency medical care. Symptoms can be life-threatening, so you need professional support and supervision.[1] 

Dehydration, heart problems, seizures, and breathing problems can all occur due to DTs. These problems can be fatal on their own, or they may exacerbate an underlying medical condition. 

Prompt medical care is always needed for DTs. Do not delay in seeking help.

Is Delirium Tremens Reversible?

Delirium tremens can be treated and reversed with prompt treatment.[1] The symptoms of delirium tremens can be controlled medically before they become a serious problem, as long as they are caught early enough. 

If you believe that you or someone you love is experiencing the onset of delirium tremens, immediately seek medical attention. It’s better if you simply have medical care before you attempt to detox from alcohol.

Damage from DTs will depend on how quickly treatment is provided. In some cases, DTs can have long-term effects on mental or cognitive health. While these effects can be treated, continued treatment is sometimes necessary.

Can Delirium Tremens Be Prevented?

Yes, delirium tremens can often be prevented and managed with medical detox. In a comprehensive treatment program, you’ll have professional support during alcohol withdrawal, and this involves medications and therapy. 

Treatment for DTs

Depending on where you are in the delirium tremens process, different medical treatments may be more or less appropriate, but your journey should begin with a consultation with a medical professional as soon as possible. 

Some of the medical treatments that may be used to treat DTs include the following:[1,2,8-12]

Medical Monitoring

Close supervision and support are essential because symptoms can worsen unexpectedly or result in a medical emergency that requires immediate intervention. 


Most often, you’ll be prescribed a benzodiazepine like lorazepam or diazepam to manage alcohol withdrawal. These medications manage tremors and agitation, helping to prevent progression to severe withdrawal symptoms. Individuals are then gradually weaned off these medications.

Medications like acamprosate, naltrexone, and disulfiram are approved by the FDA to manage AUD. In addition, you may be prescribed additional medications to manage certain symptoms, such as to manage anxiety or seizures. 


Intravenous fluids may be a necessary part of treatment to balance electrolytes and maintain hydration throughout the process. 

Nutritional Support

Proper nutrition through supplements or a balanced diet is another component of healthy recovery that will be provided in the medical setting.

Psychosocial Support

Therapy, counseling, and support groups can help to boost emotional well-being once you have reached stability in the withdrawal process.

Comprehensive Treatment for AUD

If you’ve been drinking for a long time at high levels, do not attempt to stop on your own. Delirium tremens can be life-threatening, and it is dangerous to enter alcohol withdrawal on your own. Medical care is needed to safely withdraw from alcohol once dependence is present.[13]

Once you are through alcohol detox, treatment is not done. You need comprehensive addiction treatment to address the root issues that led to your alcohol abuse. Without this kind of comprehensive care, relapse is likely as well as all the associated risks.

Updated March 22, 2024
  1. Delirium tremens (DT). Rahman A, Paul M. StatPearls. Published November 18, 2018. Accessed October 17, 2023.
  2. Delirium tremens: Assessment and management. Grover S, Ghosh A. Journal of Clinical and Experimental Hepatology. 2018;8(4):460-470.
  3. Chapter 10 - Molecular and neurologic responses to chronic alcohol use. Costin BN, Miles MF. ScienceDirect. Published January 1, 2014. Accessed October 17, 2023.
  4. Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Banerjee N. Indian Journal of Human Genetics. 2014;20(1):20.
  5. Delirium tremens. U.S. National Library of Medicine. Published 2016. Accessed October 17, 2023.
  6. CHAPTER 4 - Emergency Psychiatric Manifestations of Medical Conditions. Khouzam HR. ScienceDirect. Published January 1, 2007. Accessed October 17, 2023.
  7. A case of prolonged delirium tremens. Nicholas J, Jacob R, Kinson R. Singapore Medical Journal. Published 2013. Accessed October 17, 2023.
  8. Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Witkiewitz K, Saville, Hamreus. Therapeutics and Clinical Risk Management. 2012;8:45.
  9. Disulfiram efficacy in the treatment of alcohol dependence: A meta-analysis. Skinner MD, Lahmek P, Pham H, Aubin HJ. PLOS ONE. 2014;9(2).
  10. Clinical management of alcohol withdrawal: A systematic review. I Bharadwaj B, Kattimani S. ndustrial Psychiatry Journal. 2013;22(2):100.
  11. Management of moderate and severe alcohol withdrawal syndromes. Hoffman R, Weinhouse G. Published 2019.
  12. Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Jesse S, Bråthen G, Ferrara M, et al. Acta Neurologica Scandinavica. 2016;135(1):4-16.
  13. Management of alcohol withdrawal in the emergency department: Current perspectives. Wolf C, Curry A, Nacht J, Simpson SA. Open Access Emergency Medicine. 2020;Volume 12(1):53-65.
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