Delirium tremens (DTs)
Delirium tremens (DTs) is a severe and potentially life-threatening condition that arises from alcohol withdrawal, primarily affecting individuals with a history of heavy alcohol consumption. It is characterized by symptoms such as tremors, insomnia, hallucinations, and delusions, typically manifesting between 48 to 72 hours after the last drink. The underlying physiological mechanisms are not fully understood, but excessive alcohol intake is believed to disrupt the regulation of the neurotransmitter gamma-aminobutyric acid (GABA), leading to the DTs when alcohol is abruptly reduced or stopped. While only about 5% of those experiencing alcohol withdrawal syndrome develop DTs, the symptoms can escalate to serious complications including rapid heart rate, abnormal blood pressure, and seizures. Treatment often requires hospitalization for monitoring and management of symptoms, along with long-term strategies to address alcohol dependence, such as counseling and support groups. The condition highlights the importance of understanding the risks associated with alcohol withdrawal and the need for compassionate care for those affected.
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Delirium tremens (DTs)
Delirium tremens (DTs) is a severe form of alcohol withdrawal that often involves tremors, insomnia, hallucinations, and delusions. Commonly known as the DTs, this condition can even be fatal in some cases. The DTs occur most often in individuals who drink heavily over long periods and in people who have experienced them before. The condition usually arises when heavy drinkers or alcoholics abruptly stop drinking or reduce their alcohol intake too quickly. Although the exact physiological cause of the DTs is not known, it is believed that the condition is tied to the interference excessive alcohol consumption causes in the body's regulation of a neurotransmitter called gamma-aminobutyric acid (GABA) type A. Symptoms typically arise about six hours after the last drink and can last for up to three to five days. In the most serious cases, the DTs can lead to elevated heart rate, abnormal blood pressure, and other dangerous problems that can ultimately result in death.
Background
The DTs are the most severe symptom of a broader medical condition known as alcohol withdrawal syndrome. Like the DTs themselves, alcohol withdrawal syndrome occurs when long-term heavy drinkers or alcoholics attempt to stop drinking abruptly or drastically reduce their alcohol consumption. Alcohol withdrawal syndrome is caused by the effect that excessive drinking has on the body and the body's subsequent response when alcohol intake suddenly decreases or stops. Excessive alcohol consumption has a depressive effect on the body. Among other things, this means that heavy drinking slows brain function and alters the way nerves send signals to and from the brain. When a person drinks heavily over a long period, the body gradually adapts to the constant or near-constant presence of alcohol. Specifically, the body compensates for the effects of alcohol by working harder than usual to keep the brain in a conscious state and keep the nervous system functioning normally. When a person stops drinking heavily, the body initially remains in this overactive state for a while. It is during this period that a person who has suddenly stopped drinking will go through withdrawal.
The symptoms of alcohol withdrawal syndrome can range from mild to serious. Most individuals begin to experience mild symptoms as soon as six hours after having their last drink. These symptoms often include anxiety, shakiness, headache, nausea, vomiting, insomnia, and sweating. More severe symptoms typically begin to set in about twelve to forty-eight hours after the last drink. Serious symptoms may include hallucinations and seizures. The DTs are the most serious complication of alcohol withdrawal syndrome and often set in between forty-eight and seventy-two hours after the last drink. Only about 5 percent of individuals experiencing alcohol withdrawal syndrome endure the DTs, though.
Alcohol withdrawal syndrome is usually an easily treatable condition. In most cases, patients need little more than to rest in a quiet, supportive environment with soft lighting, limited contact with others, and plenty of food and fluids. Some patients experiencing more severe symptoms may require medicinal treatment or hospitalization. Such treatments are only a short-term solution, however. Overcoming alcohol dependence and alcohol withdrawal syndrome is a long-term task that requires great personal commitment and help from professionals and supportive loved ones.
Overview
The deliriousness that often accompanies alcohol withdrawal was first described as delirium tremens by English physician Thomas Sutton in 1813. It is also sometimes known as Saunders-Sutton syndrome. In modern times, it is commonly referred to as the DTs for short.
The DTs are formally defined as an abrupt onset of severe mental or neurological changes following withdrawal from alcohol consumption. While the DTs usually start between forty-eight to seventy-two hours after the last drink, some people may begin showing signs of the condition as much as seven to ten days after their last drink. Patients experiencing the DTs often present with the symptoms associated with basic alcohol withdrawal. These symptoms are compounded, however, with more severe symptoms like delirium, tremors, agitation, irritability, abnormally long-lasting deep sleep, excitement or anxiety, hallucinations, sudden bursts of energy, abrupt mood changes, restlessness, stupor, fatigue, and sensitivity to light, sound, and touch. Some people going through the DTs may also experience seizures. Seizures usually occur about twelve to twenty-four hours after the last drink and are most common in patients with a prior history of alcohol withdrawal issues. Other serious symptoms include rapid breathing and heart rate, abnormal blood pressure, severe muscle cramps, gastritis, and difficultly regulating body temperature. If not properly treated, these symptoms can be fatal.
Hallucinations are the symptom most commonly associated with the DTs. These hallucinations may be visual, tactile, or auditory. Patients experiencing visual hallucinations may believe they are seeing things that are not really there. Those who have tactile hallucinations often believe they feel things that are not really there, such as insects crawling over their skin. Auditory hallucinations, which are the least common type of hallucination reported in connection with the DTs, leave patients convinced they are hearing things. Many patients who experience hallucinations during the DTs report seeing frightening images and feeling disturbing physical sensations.
Doctors do not yet know exactly what causes the DTs. The most common theory is that heavy alcohol consumption interferes with the body's ability to regulate the GABA neurotransmitter. A neurotransmitter is a chemical substance that is released at the end of a nerve fiber when a nerve impulse arrives so that the impulse in question can be transmitted to another nerve fiber or somewhere else in the body. When a person drinks heavily, the body can mistake alcohol for GABA and lower the rate at which it produces that important chemical. If a heavy drinker suddenly stops drinking, the body is tricked into believing that it does not have enough GABA to function, leading to the DTs.
People experiencing the DTs usually need to be hospitalized so that their vital signs, body fluid levels, and blood chemistry can be monitored by doctors. During short-term treatment, most patients are given medicines meant to treat their symptoms and keep them calm until the DTs pass. Long-term treatment often involves a break or total abstinence from alcohol consumption, referral to counseling, and visits to alcohol support groups. In some cases, treatment for other alcohol-related conditions, such as liver disease, may also be required.
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