Alcohol Withdrawal Delirium

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.

An estimated 50 percent of people who have an alcohol addiction will experience withdrawal symptoms if they stop drinking. Of those people, 3 to 5 percent will experience AWD symptoms like grand mal seizures and severe confusion.

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?

Risk Factors

You’re at risk of AWD if you have:

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

All heavy, long-term drinkers are at risk of AWD. The Centers for Disease Control and Prevention defines heavy drinking as 15 drinks a week for men and 8 drinks a week for women.

Talk to your doctor if you’re concerned about your drinking habits. They can recommend programs that will help you stop drinking. They can also help you manage any symptoms of alcohol withdrawal you experience when you stop drinking.

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 or irritability
  • confusion
  • excitement
  • fear
  • sudden mood changes
  • delirium (an extremely disturbed state of mind)
  • sensitivity to light, sound, or 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 or 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?


Contact your doctor right away if you’re concerned about the symptoms you’re experiencing during alcohol withdrawal.

During your appointment, your health care provider 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 thiamine, or 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 and body aches (if they occur)
  • treatment for other alcohol-related conditions
  • rehabilitation to help you stop drinking

AWD can be fatal. Therefore, your doctor may suggest that you receive treatment 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


Early treatment for AWD is important. 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


The best way to prevent AWD is to drink moderately or not at all. Talk to your doctor if you think you drink heavily. They can help you quit drinking in a safe environment and prevent serious symptoms of alcohol withdrawal.

Get emergency medical help if you think you’re experiencing symptoms of AWD. You have a better chance of making a full recovery if you receive prompt medical attention.

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