Delirium Tremens (DT): the alcohol withdrawal syndrome from hell

Imagine that you are walking down the sidewalk of a city. You turn a corner and suddenly, in front of you, there is a giant grizzly bear. What happens next? You feel an adrenaline rush, your heart races, your blood pressure skyrockets, you shake like a leaf, your pupils enlarge like saucers, your hairs stand on end, you start to sweat and you run like hell. Do you have a solid mental image of this? Good. Hold that thought; we will come back to that.

Delirium tremens, also known as DT, is the most serious of several syndromes that can occur when someone who is physically dependent on alcohol stops drinking. By serious, I mean that people with this condition can die. Even with hospital treatment, the mortality rate can be 1 to 5%, but without treatment it could be as high as 20%. Even seizures, another alcohol withdrawal syndrome, are less likely to be fatal than TDs.

The symptoms of TDs usually begin 2 to 4 days after the last drink in someone who has consumed alcohol heavily and for a long time. The first signs of TD may be the three T’s: elevated temperature, tremor, and tachycardia (rapid heartbeat). The affected individual may experience anxiety, restlessness, nausea, and sleep problems. By the time delirium tremens fully develops, it includes the entire battery of “grizzly bear” symptoms mentioned above. These occur because a part of the nervous system responsible for regulating basic bodily processes, the sympathetic system, speeds up.

But DTs involve much, much more. The parts of the brain responsible for perception and thinking go haywire. Ordinary lights and sounds seem overly harsh. The affected individual becomes confused, agitated, and even psychotic. It might not even identify family members. There is a constant and sometimes incoherent conversation. Ordinary components of the environment, such as patterns on the wallpaper, can be perceived as frightening threats, such as spiders or snakes.

In addition, hallucinations can occur. These can include terrifying sights, sounds, or smells that other people in the room cannot detect. Also, there may be distressing sensations as if the skin is being touched by insects or other invisible intruders.

Initially, the person in DT may have lucid intervals in which he engages in an appropriate conversation, but then becomes increasingly inaccessible to questions. Afterwards, the symptoms usually disappear in a matter of days and the recovery can even be sudden.

What makes these terrible things happen? Evidence to date suggests that in people who drink heavily and for a long time, the brain becomes used to the constant presence of alcohol, and the normal chatter between brain cells is no longer attenuated by alcohol as it does in brains. of occasional drinkers. The brains of heavy drinkers likely accomplish this by reducing the number of places in brain cells where the natural inhibiting chemical, GABA (gamma-amino-butyric acid), can act to slow things down.

So what if the alcohol is suddenly removed from the image? In that case, the GABA in the brain has fewer locations where it can act to slow down. As a result, brain cells become uncontrollably overactive and the symptoms of delirium tremens ensue.

DTs are a medical emergency that requires hospitalization, usually in an intensive care unit. The patient needs intravenous fluids, vitamins, nutrition, and correction of salt and water imbalances in the bloodstream. Medications known as benzodiazepines are generally given to relieve overexcitement of brain cells. The medical team looks for complications, such as infections or an irregular heartbeat, that may require other treatments. Medical personnel monitor the patient frequently. Family and friends provide valuable assistance by keeping the patient calm.

But in delirium tremens, the old adage applies: prevention is better than cure. The best case is the one that doesn’t happen. Of course, this does not mean that a patient with alcohol dependence should continue to drink. Rather, it means that professional help should be sought to safely quit alcohol.

This raises the question of who is dependent on alcohol in the first place. There is more than one set of criteria, but the “CAGE” questionnaire provides a simple and efficient screen in which the letters of the word correspond to each of the four questions:

C – Have you ever felt that you should REDUCE your alcohol consumption?

R – Have people ANNOYED you by criticizing your drinking?

G – Have you ever felt bad or GUILTY about the way you drink?

E – Have you ever had a drink first thing in the morning to calm your nerves or get rid of a hangover (eye opener)?

An answer “yes” to one of the four questions raises the possibility of alcohol dependence. A “yes” answer to two of the questions makes alcohol dependence likely and help should be sought.

(C) 2005 by Gary Cordingley