Alcohol Withdrawal Delirium

Written by Rose Kivi and Elizabeth Boskey, PhD | Published on July 16, 2012
Medically Reviewed by George Krucik, MD

What Is Alcohol Withdrawal Delirium?

Alcohol withdrawal delirium (AWD) is the most serious form of alcohol withdrawal. It causes sudden and severe problems in your brain and nervous system.

Approximately five percent of hospital patients being treated for alcohol withdrawal also experience AWD. AWD is also known as delirium tremens or DTs. It is a medical emergency.

What Causes Alcohol Withdrawal Delirium?

AWD only affects people with a history of heavy alcohol use. Heavy drinkers may develop this condition if they:

  • suddenly stop drinking
  • reduce their alcohol use too quickly
  • don’t eat enough when reducing alcohol use
  • have a head injury
  • are sick or have an infection

Who Is at Risk of Alcohol Withdrawal Delirium?

You are at risk of AWD if you:

  • have been drinking heavily for a long time
  • have a history of alcohol withdrawal
  • have a history of AWD
  • have other health problems in addition to alcoholism
  • have brain damage

All heavy, long-term drinkers are at risk of AWD. However, the risk is even higher for people who have been drinking at least four to five pints of wine, seven to eight pints of beer, or one pint of hard alcohol a day for several months. It is also very high for people who have been drinking heavily for more than 10 years.

What Are the Symptoms of Alcohol Withdrawal Delirium?

Symptoms of AWD usually occur within three days of changing alcohol use. However, sometimes they may take a week or more to appear. Symptoms of AWD may include:

  • anxiety
  • agitation
  • irritability
  • confusion
  • excitement
  • fear
  • sudden mood changes
  • delirium (an extremely disturbed state of mind)
  • sensitivity to light
  • sensitivity to sound
  • sensitivity to touch
  • delusions (irrationally believing things that are untrue)
  • hallucinations (seeing or hearing things that are not there)
  • nightmares
  • fever
  • fatigue
  • nausea
  • restlessness
  • chest pain
  • stomach pain
  • increased heart rate
  • increased breathing rate
  • excessive sweating
  • increased startle reflex (an exaggerated reaction to unexpected stimuli)
  • involuntary muscle contractions
  • seizures
  • eye and muscle movement problems

How Is Alcohol Withdrawal Delirium Diagnosed?

Your doctor will perform a physical exam to see if you have AWD symptoms. Some tests that may be needed for a diagnosis include:

  • a toxicology screen to look for alcohol in your blood
  • blood tests to measure magnesium and phosphate
  • a comprehensive metabolic panel
  • an electrocardiogram (ECG) to check your heart function
  • an electroencephalogram (EEG) to record the electrical activity in your brain

You may also be tested for other medical conditions related to alcohol use, such as:

  • alcoholic liver disease
  • alcoholic neuropathy (nerve damage caused by alcohol use)
  • alcoholic cardiomyopathy (weak heart muscle due to alcohol use)
  • Wernicke-Korsakoff syndrome (brain damage from a lack of vitamin B1)

How Is Alcohol Withdrawal Delirium Treated?

Treatments for AWD may include:

  • intravenous fluids
  • anticonvulsants to prevent or stop seizures
  • sedatives to calm agitation and treat anxiety
  • antipsychotic medications to prevent hallucinations
  • medication to reduce fever
  • treatment for other alcohol related conditions
  • rehabilitation to help you stop drinking

AWD can be fatal. Therefore, treatment should be received in a hospital. It may take up to a week for you to feel better.

Complications of Alcohol Withdrawal Delirium

People with AWD are at increased risk of:

  • injuries from falling during a seizure
  • injuring themselves or someone else while confused
  • developing an irregular heartbeat

Prognosis of Alcohol Withdrawal Delirium

AWD can be deadly. This is particularly true if it remains untreated. Treatment significantly lowers your risks of complications and death.

With timely medical treatment, AWD has very low death rate. However, some symptoms of alcohol withdrawal may last for more than a year. These include:

  • mood swings
  • fatigue
  • sleeplessness

Preventing Alcohol Withdrawal Delirium

To prevent AWD, do not drink alcohol.

If you are already a heavy drinker, get help. Your doctor can help you stop drinking more safely than you can stop alone.

If you suddenly stop drinking, you may end up with symptoms of AWD. If you do, get immediate medical help.

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