Alcohol Withdrawal – What Is Delirium Tremens and Is It Dangerous?

Alcohol withdrawal occurs when someone who’s dependent on alcohol stops and experiences side effects. There are a variety of symptoms and side effects that range in severity. The most dangerous of these side effects are delirium tremens. This symptom of alcoholism is a result of heavy drinking for a long period of time. It is why someone should get professional detox when they abstain from alcohol. Recovering from alcohol addiction should always be managed properly to avoid the risk factors.

While there are addictions that come with their challenges, recovery from drinking is a concern. You may suffer from normal symptoms such as insomnia, irritability, and loss of mental functioning. They might be uncomfortable, but not life threatening. If there is a risk of alcohol tremens, you would need to be put on some type of benzodiazepine tapering in order to avoid the potential of it.

“When you are young, your body cannot handle alcohol, and when you get old, your mind cannot handle it. Either way, alcohol has its way.”

~Robert Black

Alcohol is the most widely-used intoxicating substance throughout the world, including here in America. Four out of five people in this country over the age of 12 have tried drinking.

In 2014, an estimated 16.3 million adults in the U.S. were diagnosed with an Alcohol Use Disorder (AUD) – equating to 9.2%of men and 4.6% of women.

Alcohol abuse kills almost 88,000 Americans every year, making it fourth on the list of preventable deaths. Almost 10,000 of those deaths are due to driving fatalities involving alcohol impairment –31% of all vehicular deaths.

For someone who has been drinking excessively, it can become abusive. This can become a life-or-death situation for alcoholics. So can quitting.

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Alcohol Withdrawal is Serious Business

When a person has been abusing it for a long enough period of time, they can develop a tolerance and a physical dependence on alcohol.

When a person has developed a physical dependence on alcohol, it is because their brain has adapted to the presence of alcohol. This obviously occurs from long-term abuse, long enough for the functions of the body to become so dependent. When the person dependent on alcohol STOPS drinking, there is a hyper-excitable “rebound” response from the person’s autonomic and central nervous systems. This is known as delirium tremens. It will primarily occur in those who have been drinking heavily for a period and haven’t eaten enough food. These life-threatening side effects can be caused by head injuries, illness, benzodiazepine withdrawal or alcohol withdrawal. It happens in people with a history of heavy drinking who attempt to stop cold turkey.

Because of the bodily systems affected, alcohol withdrawal symptoms can vary widely – from mildly uncomfortable to severely disturbing –

  • Tremors
  • Agitation
  • Anxiety
  • Irritability
  • Insomnia
  • Nausea/Vomiting
  • Severe alcohol craving

But as unpleasant as these symptoms are, there are severe symptoms that can progress so far as to be life-threatening –

  • Hallucinations – visual, auditory, and tactile
  • Autonomic instability
  • Tonic-clonic seizures

But the most serious form of alcohol withdrawal is delirium tremens, also known as “the DTs” or “the shakes”.

What Need to Know about the Dangers of Delirium Tremens

Alcohol tremens has been known as a condition that can occur to long-term heavy drinkers. Since the 1700s, it was colloquially called the “drunken horrors”. It is a form of mental or nervous system changes that come from abstaining from drinking. There is debate on what causes DTs. The most common reason tends to be that drinking a lot of alcohol influences how the body regulates the GABA neurotransmitter.

The body mistakes alcohol for GABA so it decreases the production of it. When a heavy drinker stops and levels of alcohol drop in the body, the body thinks there isn’t enough GABA to function. Every person will experience DTs differently. The amount of time it will last depends on any given patient. The brain needs time to readjust the balance of excitation and inhibition. This process takes at least a few weeks and may take up to a few months.

Delirium tremens are characterized by:

A rapid onset of symptoms, usually developing 2 to 3 days after the cessation of heavy drinking, with the worst manifestations occurring on the fourth or fifth day. These symptoms include:

  • Shivering
  • Shaking
  • Irregular heartbeat
  • Autonomic hyperactivity – tachycardia and hypertension
  • Profuse sweating
  • Extremely high body temperature
  • Seizures
  • Panic attacks
  • Paranoia
  • Horrific nightmares
  • Global confusion
  • Acute disorientation
  • Hallucinations with no recognition of the real world
  • Perceptual disturbances
  • Formication – a sensation that small insects are crawling on or under the skin
  • An intense feeling of impending doom or death

Who Is Most at Risk for Delirium Tremens?

Delirium tremens occurs in up to 20% of patients undergoing alcohol detoxification and up to 33% of those patients already experiencing withdrawal seizures. So who exactly is most at jeopardy when withdrawing from drinking?

Alcohol tremens are most common in those individuals who:

  • Have a history of alcohol withdrawal
  • Drank heavily every day for several months which is considered to be4-5 pints of wine, 7-8 pints of beer, or one pint  of hard alcohol daily for a period of many months.
  • Have a personal history of alcoholism or chronic alcohol abuse of more than 10 years

Can Withdrawal from Alcohol Cause Seizures?

So what kind of seizure is it that comes when one abstains from heavy drinking? It’s known as a grand mal seizure. It can cause you to lose consciousness and have muscle contractions that are uncontrollable. It’s also known as a generalized tonic-clonic seizure and is happens due to abnormal electrical activity occurring in the brain.

The worst day of withdrawal may include seizures for heavy drinkers. This will usually occur between seven to 72 hours after one stops drinking. There are other reasons that tonic-clonic seizures may occur as well. Triggers for grand mal seizure can come from low levels of sugar, salt, magnesium, and calcium in the body. Certain drugs can also cause seizures. Toxic effects of alcohol, too much fluid, and changes in the body can cause seizures. Binge drinking has the potential to cause seizures for people who don’t suffer from deficiencies or who don’t have epilepsy.

These seizures are what makes quitting drugs and alcohol even more challenging than with other substances. If you don’t withdraw properly, you put yourself at risk of death. This is why it’s important to go through a professional detox. While there are home remedies for withdrawal, this puts you at risk of out of control alcohol tremens that could lead to serious problems.

How Long Does Alcohol Take to Detox From?

Perhaps an intervention took place to help the alcoholic see that they have a problem. The first step in recovery is the detoxification phase. This is a dedication to getting alcohol and toxins out of the body so treatment can begin. The goal in detox is to abstain from drinking in the safest and most comfortable way so you succeed. This period of abstinence is the start of the road to recovery. Getting ‘clean” will allow you to start recovering.

When alcohol is no longer in the system, the brain will struggle to adjust itself. The level of stimulation will bounce radically, to the point the brain can’t keep up. The neuronal activity can then cause seizures known as DTs. The risk for seizures can last for many days. This is why it’s necessary to remove all toxins from the body first before trying to move forward with the next steps of recovery. Once the initial discomfort is over, it’s much easier to just focus on recovering.

Detox can last for quite a few days once the alcohol withdrawal symptoms start. The cravings will get greater and the body will become more uncomfortable. If there is the potential for seizures and it’s not supervised closely, they can continue and even worsen. After 48 hours, the potential for seizures will lessen. However, it’s still important to be monitored due to confusion and cardiovascular risks. This includes hearts attacks or strokes. After the last drink, these dangerous symptoms can happen for 48-96 hours after the last drink was consumed. There is potential of a delayed reaction to withdrawal that can start from 7-10 days after the last drink.

Can Withdrawal from Alcohol Cause Hallucinations?

The answer is yes. Withdrawal can include hallucinations that occur with other dangerous side effects. This includes high fever and seizures. Tactile hallucinations can include itching, burning or numbness. It feels real but isn’t actually happening. There are auditory hallucinations that may occur which includes hearing sounds that aren’t there. Visual hallucinations will include seeing things that aren’t there.

Withdrawal Timeline

You know what the alcohol withdrawal signs are but you may not know when they will arise. Here is what you can expect timewise.

The first few hours of detox may include cravings as the initial symptom. Cravings can begin within just a few hours after drinking has stopped. They will likely continue for most of the detox process. Other symptoms include:

  • Feeling physically ill.
  • Feeling moody such as anxiety, depression, and irritation.
  • The heart and blood pressure may spike.
  • Nightmares.
  • Insomnia.
  • Tremors may occur.

When someone has extensive addictions, the symptoms may be much worse through the detox period and DTs are a higher risk.

The first 48 hours can come with severe symptoms that include hallucinations to delirium tremens. This is the brain reacting to alcohol leaving the system. Seizures can occur in the first 12 hours of detox and can continue to be a risk for days after. The heart may become more rapid and one might even experience chest pain. Blood pressure may also rise.

Most people will experience the symptoms of withdrawal for more than 48 hours.

What Helps Ease Withdrawal Symptoms?

Easing withdrawal symptoms doesn’t necessarily mean you’ll be safe from the dangerous side effects. However, there are ways to ease the discomfort. When you attend an addiction treatment facility, they will ensure that you’re as comfortable as possible. Guidelines for withdrawal are constantly being paid attention to and updated. These are some of the things that can help ease the symptoms:

  • Drink plenty of fluids that have electrolytes. You are suffering from dehydration and will likely feel nauseous as a result. It will help to combat those effects.
  • A quiet place with soft lighting.
  • Very little contact with people.
  • An atmosphere that is positive and supportive.
  • Health, nutritious foods that replenish the body so it can fight the effects of withdrawal more efficiently.

Your blood pressure, pulse, heart rate, and body temperature may rise. Medications that can help treat symptoms like seizures include benzodiazepines. They also help with anxiety and insomnia. Anti-seizure medication and antipsychotics may also be utilized within the detox setting. Keep in mind that there is a difference between holistic and medical detox. You’ll want to determine what will be the right route for you as there are pros and cons for each.

Medications for Detox

The most common drugs used to reduce alcohol withdrawal symptoms are benzodiazepines. Dosing will be guided by the CIWA scale.They include:

  • Librium (chlordiazepoxide)
  • Valium (diazepam)
  • Ativan (lorazepam)
  • Serax (oroxazepam)

The medication will be used within various treatment patterns. Detox from alcohol is an abrupt cessation of consumption. These drugs are a substitute because they have similar effects to alcohol on the brain. A standard dose of benzodiazepine will be given every 30 minutes until the patient is lightly sedated. This will determine the baseline. Medication is then tapered over a period of 3-10 days.

Another method is to give a dose of benzodiazepine based on the history of the patient. It can then be adjusted based on the results of withdrawal.

The third option would be to not use medical detox until the symptoms begin. This would be an initial holistic approach. If a patient has had alcohol-related seizures, this method isn’t an option.

There are a few different types of benzodiazepine medication that can be utilized.

Librium is used for uncomplicated alcohol withdrawal because of it’s long half-life.

There is an injection available for those who likely can’t safely take medications. It may be that they will look to abuse them or perhaps not take them at all. These injections will be lorazepam or diazepam.

Lorazepam and oxazepam will be used for patient who have damaged their liver.

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