Alcohol Withdrawal Delirium

Despite the various health, occupational and social consequences associated with alcohol use disorder (AUD), many individuals find it challenging to quit their chronic alcohol consumption. One of the primary causes of this is the manifestation of alcohol withdrawal syndrome (AWS), which occurs with the abrupt cessation or reduction of alcohol after prolonged heavy drinking. 

Alcohol withdrawal syndrome is characterized by a spectrum of physical and psychological symptoms, ranging from minor symptoms like insomnia and trembling to severe complications like withdrawal seizures and delirium tremens (DTs). This article describes alcohol withdrawal delirium (AWD) and its causes, symptoms, diagnosis, and treatment to help you find the most appropriate treatment.

What Is Alcohol Withdrawal Delirium?

Alcohol withdrawal delirium is the most severe form of alcohol withdrawal, characterized by profound confusion, autonomic hyperactivity, and cardiovascular collapse. According to the U.S. National Library of Medicine, AWD is rare and occurs in only 2% of patients experiencing acute alcohol withdrawal. However, if left untreated, alcohol withdrawal delirium can lead to a heart attack, stroke, or death.

Disruption of consciousness, a sudden shift in cognition or perceptual disturbance, and the onset of symptoms soon after discontinuing heavy alcohol consumption are currently accepted as diagnostic criteria for AWD. Clinical management of alcohol withdrawals during detoxification is imperative to reduce the risk of delirium tremens.

Symptoms of Delirium Tremens

DTs often appear two to four days in the alcohol withdrawal timeline but may appear as late as seven to 10 days after the cessation of alcohol use. The average duration of delirium tremens is two days, but in certain circumstances, the condition can persist for up to five days following its onset. DTs are associated with severe withdrawal symptoms ranging from unpleasant to life-threatening.

• Agitation
• Anxiety
• Insomnia
• Fatigue
• Nausea and vomiting
• Hand tremor
• Sensitivity to light, sound, and touch
• Chest pain
• Severe autonomic hyperactivity (tachycardia, fever, sweating, and hypertension)
• Delirium, or severe confusion
• Hyperthermia
• Alcoholic hallucinosis
• Changes in mental function

Seizures can also occur, with or without the other symptoms of AWD. The most common are generalized tonic-clonic seizures, which affect the entire body and can lead to hallucinations and dizziness. These seizures can also cause violent muscle contractions and loss of consciousness.

Risk Factors of Alcohol Withdrawal Delirium

People who consume excessive amounts of alcohol regularly or have a physical dependence on alcohol are more likely to develop AWD. Other contributing risk factors for delirium tremens include:

• Being older
• A history of AWD
• Previous experiences with alcohol withdrawal
• A history of alcohol withdrawal seizures
• The presence of a concurrent medical illness
• The presence of a psychiatric disorder
• Being in poor overall health

Diagnosis of Alcohol Withdrawal Delirium

During the clinical diagnosis of acute alcohol withdrawal, healthcare professionals will evaluate your medical history, inquire about your alcohol intake and previous and current withdrawal symptoms, and conduct a physical examination. For a more thorough assessment of your addiction and withdrawal symptoms, you may also be required to take the following tests:

• Toxicology screen – helps determine how much alcohol is in your body. Toxicology screening is usually done with a blood or urine sample and can also help detect the presence of other agents. If you are receiving inpatient treatment, your physician may perform toxicology screens more than once to monitor the presence of alcohol in your body.
• Blood magnesium level – can be evaluated through a simple blood test. Low magnesium levels indicate alcohol addiction or severe alcohol withdrawal syndrome.
• Blood phosphate level – Low phosphate levels can also indicate alcohol addiction.
• Comprehensive metabolic panel – This blood test requires fasting. Abnormal results indicate alcoholism and issues with your overall health, including liver and kidney functioning.
• ECG (electrocardiograph) – looks for irregularities in your heart’s electrical activity. Because patients experiencing alcohol withdrawal may develop heart palpitations or arrhythmias, this test can aid in determining heart health and the severity of alcohol withdrawal.
• EEG (electroencephalogram) – can help detect electrical irregularities in the brain. It can help monitor patients undergoing severe alcohol withdrawal symptoms, especially those prone to or experiencing seizures.
• A lumbar puncture test – may be used to examine spinal cord fluid.
• MRI (magnetic resonance imaging) – may be used to look for signs of seizures or head injury.

Healthcare providers may also utilize the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) to help determine and gauge the severity of your alcohol withdrawal symptoms. A score of 15 or above indicates that you are at a higher risk for developing AWD.

Early diagnosis can help reduce the likelihood of medical complications or injury resulting from AWD or related conditions. 

Treatment of Delirium Tremens

Treatment for alcohol withdrawal delirium begins at a hospital, as it is a medical emergency. The healthcare team will regularly check blood chemistry results, such as electrolyte levels, body fluid levels, and vital signs, such as temperature, pulse, breathing rate, and blood pressure to monitor your condition and manage any complications. Intravenous fluids will be administered to balance electrolytes and avoid dehydration. 

Hospitalization for delirium tremens can last for about a week and is aimed at controlling agitation, reducing seizure threshold, and decreasing mortality. Thereafter, alcohol-dependent patients will be required to undergo treatment for alcohol dependence.

Treatment of Alcohol Dependence 

Medical alcohol detoxification is often the first stage of treatment for alcohol dependence. However, alcohol-dependent patients recently discharged from the hospital for DTs may not need it, as they have already detoxed in the hospital. Following the completion of medical detox, patients will enter either an inpatient or outpatient program for alcohol addiction that utilizes a multifaceted approach to treatment that incorporates various forms of therapy (such as individual and group therapy, CBT, and family counseling) to get to the bottom of the patient’s alcohol dependence. Inpatient care often lasts for 30 to 90 days, depending on the severity of the alcohol dependence, whereas outpatient management lasts for three to 12 months.  

Medical comorbidities are common among patients with alcohol use disorder. Such individuals may benefit from a treatment program designed for those with dual diagnosis because it can help them with both disorders at once. In addition to these treatments, support groups such as Alcoholics Anonymous (AA) and other 12-step programs can offer a valuable added layer of support for patients with alcohol dependence going through recovery. 

If you’re ready to get sober, Futures Recovery Healthcare is here to help you every step of the way. Our team of specialists utilizes a wide range of treatments that have proven effective for alleviating withdrawal symptoms of varying severity and providing continuous support for patients. The intricacy of mental health care is embraced by our team so that we may better aid in patient and family healing.