Delirium tremens: a severe withdrawal syndrome

Throughout history, society has assimilated the consumption of alcoholic beverages, becoming a characteristic of some cultures. It is something that can be observed at parties, concerts and discos, traditions, as part of the leisure habits of youth and even in the popularity of phenomena such as large bottles.

However, it must be taken into account that alcohol consumption can generate addiction, the drinker losing control of the intake, thus generating dependence on the substance. And this dependence is not only expressed through substance abuse, but also through signs and symptoms that appear when you stop drinking alcohol. Among the most serious phenomena of alcohol withdrawal is the delirium tremens. Let's see what it consists of.

The Mechanics of Withdrawal

Once a dependency has been generated, the fact of removing the object to which one is dependent causes withdrawal syndrome, that is, the absence of the substance in the body causes symptomatic reactions. That is why in many cases ending alcoholism is not as simple as withdrawing the possibility of consuming this type of drink once and for all. The lack of this substance also produces a series of symptoms that, at times, can be dangerous in themselves.

Generally, the opposite effect to that caused by the substance occurs, which means that in the case of a depressant substance (such as alcohol), They will produce manic-type symptoms, while in the case of exciting ones the withdrawal syndrome will consist of a decrease in the general activity of the organism. In any case **, the withdrawal of the desired substance must be controlled **, because too abrupt cessation of supply can cause these syndromes.

Among the withdrawal syndromes related to alcohol abuse, the one considered the most serious is called delirium tremens.

What is delirium tremens?

Delirium tremens is called acute confusional picture produced by alcoholic deprivation. It is caused by the interruption of alcohol intake in chronic drinkers who have developed a physical dependence, and it often appears after 4 to 72 hours of abstinence.

Although delirium tremens usually occurs in patients who stop drinking after excessive alcohol consumption, it is possible to find cases in which this syndrome has been caused by disease, trauma or infection in individuals with high alcohol consumption in the past.

Symptoms of delirium tremens

The main symptoms of this syndrome are a disintegration of consciousness in which visual hallucinations, delusions, emotional lability and stupor appear. Tremors, psychomotor agitation, and seizures are also common.

Generally, delirium tremens has a short duration, but regardless of this it is a dangerous syndrome, since a 20% of the cases are fatal if they do not receive medical attention, and even with this, 5% of the cases end in the death of the patient.

Phases of delirium tremens

In a first phase, vegetative symptoms such as anxiety, tachycardia, dizziness, restlessness and insomnia, caused by a rise in norepinephrine in the blood. If the second phase is reached, around 24 hours after its appearance, the intensity of the above symptoms increases, with uncontrollable shaking and heavy sweating. Seizures may also appear.

Finally, in the third phase (defining delirium tremens), an altered state of consciousness called drowsiness appears. This is defined by a propensity for distraction and confusion, along with deep disorientation. The most characteristic of this phase is the appearance of visual hallucinations (usually microzoopsias) and delusions, together with a high sense of anguish. Likewise, agitation, tachypnea, hyperthermia and tachycardia are also present.

Possible treatments

Taking into account that delirium tremens is a problem that can cause the death of the patient, it is requires the immediate hospitalization of those who present the symptoms described, and it may be necessary to enter the ICU.

The treatment to be applied will have as basic objectives to keep the patient alive, avoid complications and alleviate symptoms. Thus, the surveillance of the affected person will be constant, observing their hydroelectric balance and vital signs.

Although the specific measures will depend on the case, the administration of diazepam, lorazepam and dipotassium chloracepate are frequently applied to achieve sedation. of the patient, the hydroelectrolyte control in order to maintain the hydration of the affected and administration of vitamins to maintain the correct functionality of the organism. In addition, haloperidol is also often used to control the psychotic process and hallucinations.

A final consideration

While binge drinking is a dangerous phenomenon, and those who stop drinking do so for good reasons, it is It is necessary that those who decide to quit alcohol take into account the physical dependence that their body maintains on that substance.

It is essential in cases of addictions or substance use for a long time (including medications such as tranquilizers or antidepressants), that the Withdrawal of the substance occurs gradually, since in the initial stages the body needs a certain dose of the substance to continue to function properly.

Also, it should be remembered that the type of health hazards associated with delirium tremens can be avoided. detecting cases of alcohol addiction early, which allows you to close the way to alcoholism in time. The use of this class of drinks is socially very accepted and widespread in all kinds of contexts, and that is why Detecting its first signs can be complicated, given the degree of normalization of the abuse of these substances.

To know some of the signs that indicate the presence of the beginnings of alcoholism, you can read this article: "The 8 signs of alcohol addiction".

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
• Correas, J.; Ramírez, A. & Chinchilla, A. (2003). Psychiatric Emergency Manual. Masson.
• Ferri, F.F. (2015). Delirium tremens. In: Ferri FF, ed. Ferri's Clinical Advisor. 1st ed. Philadelphia: PA Elsevier Mosby; p. 357.
• Golberg, D. & Murray, R. (2002). The Maudsley hanbook of practical psychiatry. Oxford
• Marta, J. (2004). Practical approach to delirium. Masson.
• O'Connor, P.G. (2016). Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; chap 33.