Updated 21 May 2015

Delirium tremens

Delirium tremens is a severe withdrawal syndrome from alcohol.

Alternative names

“The DTs”


Delirium tremens is a severe withdrawal syndrome beginning with anxiety, increasing confusion, poor sleep with frightening dreams, marked sweating and profound depression.

This severe syndrome may start 12 to 48 hours after stopping alcohol.

Symptoms and signs

The DTs will include at least two of the following symptoms, which occur because of significant nervous system changes:

  • nightmares
  • anxiety, panic attacks or severe mood swings
  • panic attacks
  • dyspepsia (indigestion, acid stomach, upset stomach)
  • restlessness
  • tremors (shaking movements resulting from involuntary, alternately contracting and relaxing muscle groups)
  • inability to sleep, or daytime sleepiness
  • delusions and hallucinations (hearing, seeing or feeling things that are not there, often small creatures)
  • disturbed behaviour and confusion
  • major memory disturbances (patients may not be able to recognise family and friends)
  • dizziness
  • rapid heartbeat (also known as tachycardia)
  • fever
  • dilated pupils
  • sweating
  • convulsions / seizures (if the patient is not treated)


The diagnosis is based on the classical clinical picture of the withdrawal state, along with a history of chronic alcohol abuse.


The best prevention is to deal with alcohol dependence before it becomes a chronic, life-threatening problem.

If alcoholism is treated in its early stages, by not drinking, medical complications such as the DTs can be avoided.

It is important for chronic drinkers to inform their doctor and caregivers if they have to go to hospital for some reason, so they can prevent withdrawal from occurring. Not doing so could lead to serious complications.

Alcoholics Anonymous (AA) meetings are free and open to everyone. In many cities, there are several meetings every day at various locations. Refer to your telephone book for a contact number and more information about AA (for alcoholics) or Al-Anon (for families of alcoholics).


An initial medical examination is needed to detect any other illness that may complicate the picture or have precipitated withdrawal. This will also rule out any nervous system pathologies which may result from previous injury and which might mimic the withdrawal syndrome or be masked by it.

Delirious patients are very suggestible and respond well to reassurance. Generally they should not be restrained. Fluid balance must be maintained and large doses of vitamins C and B complex, particularly thiamine, must be given immediately. Electrolyte balance in the blood should be monitored.

Some drugs often used to treat alcohol withdrawal are similar to alcohol in their pharmacological effects. All patients who are withdrawing from alcohol can be given nervous system depressants, but not all need them. When drugs are needed, diazepam is the most frequently used. Some sort of tranquiliser is usually needed. Medication needs to be monitored by a medical doctor.

Once the patient is stable, counselling on alcoholism should begin while still in hospital. Patients should ideally be discharged with an appointment with an organisation such as Alcoholics Anonymous already made.


The symptoms of delirium tremens usually last from one to five days. They can however last for as long as 10 days. Up to 15% of patients die from delirium tremens if it is not treated.

When to call the doctor

Do not try to withdraw from heavy, prolonged use of alcohol without help. If you or any member of your family experience symptoms of the DTs, seek medical help immediately.

Reviewed by Dr Rudoph Otto


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