Delirium Tremens Definition and Meaning

Delirium Tremens Definition and Meaning

The Delirium tremens is a Alkoholentzugsdelir. It is also called alcohol withdrawal syndrome and, according to ICD-10, is one of the mental and behavioral disorders caused by alcohol.

What is delirium tremens?

The term delirium tremens is derived from the Latin words delirium (“insanity”) and tremere (“tremble”). It is a complication of chronic alcoholism. In most cases, the delirium occurs during alcohol withdrawal. But it can also be triggered by intoxication. The lethality of untreated delirium tremens is 26 percent. That is why an emergency admission to a clinic is necessary in the event of impending or beginning delirium.

Causes

According to DigoPaul, delirium tremens is the result of longstanding alcohol dependence. In most cases it occurs in withdrawal. The delirium usually begins 48 to 72 hours after the last alcohol consumption. Around five percent of all alcohol addicts suffer from delirium tremens at least once in their life. The risk of recurrence is high at ten to twenty percent. The risk of suffering delirium tremens during controlled alcohol withdrawal is less than one percent.

Delirium is often caused by illnesses caused by alcohol consumption. Alcoholics often suffer from gastrointestinal bleeding, cirrhosis of the liver, or pneumonia. If the patient is admitted to hospital because of these illnesses and no longer receives alcohol there, alcohol delirium can occur.

Delirium is triggered by an imbalance in neurotransmitters. Neurotransmitters are messenger substances that are responsible for transmitting signals between nerve cells in the central nervous system (CNS).

Symptoms, ailments & signs

Around half of all deliria begin with an epileptic seizure. However, the seizures are rather inconspicuous, so that they are often misinterpreted as an alcohol-related absence. At this stage the alcohol delir is not yet complete. It is therefore also referred to as predelirium. The full picture of the disease develops within a few days. The clinical symptoms are divided into psychiatric, neurological and vegetative symptoms.

Psychiatric symptoms include visual hallucinations and anxiety. Often these two symptoms occur in combination. The patients are not oriented in terms of time, place or situation. In addition to hallucinations, there are also illusory misjudgments. With hallucinations, patients perceive something that is not there. In the case of the illusionary misunderstanding, reality is perceived and interpreted incorrectly.

A typical neurological symptom is tremor. This is a gross tremor of the hands. Patients are also confused and not always conscious. The impairment of consciousness can progress to a coma. In addition, both tonic and clonic convulsions can occur.

Vegetative symptoms of delirium tremens are sweating, increased blood pressure, an increased respiratory rate and an increased pulse. In the case of untreated delirium tremens in particular, the vegetative symptoms can derail. Such courses can be fatal. 25 percent of all untreated patients die.

The prognosis worsens in the elderly and in patients who have repeated delirium. In most patients, however, there is a significant improvement in symptoms after three to six days. In individual cases, however, delirium tremens can last up to twenty days. Slight vegetative complaints, sleep disorders and anxiety can be left behind. Often these complaints are the reason why patients resort to alcohol again and relapse.

Diagnosis

The symptoms provide the first and in some cases very clear indications for the diagnosis. The disease must be differentiated from other states of restlessness, from feverish delirium, from an extreme urge to urinate, from an overdose of asthma medication, from hypoglycaemia or from meningitis.

Personal and third-party anamnesis is also important. Caution is advised here, however, as relatives may tend to conceal the patient’s symptoms and complaints out of a feeling of shame. Another possibility for diagnosis is the administration of alcohol. This can be done orally or venously. If the patient’s symptoms are really based on delirium tremens, the symptoms will disappear within a few minutes.

Complications

As a rule, there are severe withdrawal symptoms and psychological complaints in delirium tremens. These can also lead to behavioral disorders and thus greatly reduce the patient’s quality of life and limit everyday life. In many cases, the delirium tremens relapses and the patient becomes addicted to alcohol again.

It is not uncommon for the delirium to result in an epileptic attack. Those affected suffer from severe anxiety and sweating. In severe cases, hallucinations can also occur, so that the patient can no longer orient himself and also lose track of time. The hands are shaking and cramping.

If the delirium tremens is not treated properly, it can lead to death in the worst case. Death occurs from heart failure because the heart rate is increased and the blood pressure is also increased. Those affected often cannot sleep at night and therefore suffer from irritability during the day.

If there are no complications in the first few days, no particular complaints will occur. Withdrawal symptoms usually go away after about a week, allowing the person to wean themselves off the alcohol.

When should you go to the doctor?

Whether delirium tremens becomes life-threatening depends on the history and severity of the alcohol dependence as well as on the general condition of the patient and on the symptoms.

“Ordinary” and usually harmless withdrawal symptoms such as high blood pressure, palpitations, tremors, sleep disorders and restlessness appear soon after you stop drinking, but their intensity decreases after two days. If no worsening of the condition is observed at this stage, it is also not necessary to see a doctor.

In contrast, delirium tremens, which is also characterized by hallucinations, disorientation and paranoia, does not set in until a few days after the onset of alcohol abstinence. If these symptoms occur, it is advisable to consult a doctor immediately.

Only a specialist in neurology can clearly determine whether delirium tremens is present and whether hospitalization is required. Withdrawal from alcohol that has no specific indications of delirium tremens can also take place on an outpatient basis, under the supervision of the family doctor or without medical supervision.

Treatment & Therapy

If delirium tremens is suspected, an emergency doctor should be called immediately. If the disease is fully developed, treatment is usually carried out in the intensive care unit. Often the patients are very restless and aggressive. Psychotic states also occur regularly. Treatment with sedatives such as diazepam or clomethiazole is therefore necessary. When these drugs are administered, patients must be closely monitored. The substances used have a respiratory depressive effect and can cause respiratory arrest.

Depending on the symptoms, other drugs such as haloperidol or clonidine can be administered. To prevent tonic and clonic withdrawal convulsions, carbamazepine is prescribed in some cases. The alcohol delirium can also be interrupted by giving alcohol intravenously. However, this therapy is usually only chosen if another disease has to be treated before the delirium. An example of this is bleeding in the gastrointestinal tract.

These are only made worse by the added delirium. The administration of alcohol also only works in the predelirium. A fully developed delirium tremens cannot be stopped. The fluid and mineral balance of the patient is also monitored. Those affected must be protected from self-harm and from being hypothermic.

Outlook & forecast

Delirium tremens is an acute health situation that has an unfavorable prognosis for many patients. Without immediate emergency medical care, the life-threatening condition ends in 30% of the cases with the death of the patient.

The prognosis worsens with increasing age and the duration of the delirium tremens. Affected people who repeatedly suffer from delirium are also considered to be at risk. If the risk factors can be ruled out and if rapid medical care is possible, the patient will experience an improvement in their health within a few days.

Symptoms are usually relieved within three to six days. The healing process takes up to three weeks, especially in older patients. Complete freedom from symptoms is often not achieved in delirium tremens.

Many patients experience lifelong impairments that represent a heavy burden in everyday life. Sleep or anxiety disorders occur, which can lead to a relapse of the underlying disease delirium tremens. The longer the delirium tremens lasts, the worse the prognosis for the underlying disease. This increases the risk of a relapse into alcohol addiction and the recurrence of delirium. Many patients have to be cared for in a nursing home after the delirium tremens because they do not experience any healing due to the clinical picture.

Prevention

Delirium tremens can usually be avoided through controlled withdrawal. Alcoholic patients who are in inpatient treatment for another illness are usually given small amounts of alcohol during treatment so that delirium does not occur.

Aftercare

Since delirium tremens can develop during or after alcohol withdrawal, follow-up care is designed according to future addictive behavior. If one is addicted to alcohol, there is usually a lifelong risk of relapse after withdrawal. Those who had delirium tremens were usually already heavily dependent on alcohol and must change their future way of life in order not to relapse again.

Especially after delirium tremens, many sufferers fall back into their alcohol addiction in the first year because they resume old habits or are overwhelmed by everyday life. It is therefore not uncommon for inpatient rehabilitation to be prescribed as follow-up care after withdrawal. During this rehab the patient learns to come to terms with old habits and to control his or her addictive behavior.

Follow-up treatments by psychotherapists are also common. With their help, addicts learn certain rules of behavior that are intended to prevent alcohol consumption in the future. Psychotherapy can be done either on an outpatient or inpatient basis with a specialist or in a specialist clinic. There are numerous addiction counseling centers, specialized psychotherapists and psychiatrists, and self-help groups.

These help to return to a normal life after delirium tremens and support an abstinent lifestyle for the future. Drugs designed to reduce alcohol cravings are rarely prescribed as follow-up treatment. Regular control and self-help is extremely important after a delirium tremens.

You can do that yourself

At the moment when the person suffers delirium tremens, there is very little he can do for himself. If he can, he can call an emergency doctor. Often, however, this will have to be taken over by people in the immediate vicinity.

As a preventive measure, the person affected has various options that he can use to avoid the condition. First and foremost is the monitoring of the amount of alcohol consumed in everyday life. Alcohol disease develops over a period of several years. As soon as the person concerned notices that they can no longer manage their lifestyle without the consumption of alcohol, they should seek help.

If this does not happen in time, delirium can occur in an intoxication or self-chosen withdrawal. Withdrawal from alcohol must take place in a controlled manner so that delirium tremens can be avoided. If the person concerned tries it on their own, he is taking unnecessary risks that can lead to life-threatening complications.

Medical help is needed as soon as the first signs of an unexpected course appear. If uncontrolled tremors set in, the best decision for those affected is to seek medical treatment for their own sake. In advance, he should, if possible, find out about his illness and possible contact points.

Delirium Tremens