Delirium tremens overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Overview
Delirium tremens (colloquially, the DTs, "the horrors", "the shakes" or "rum fits"; afflicted individuals referred to as "jitterbugs" in 1930s Harlem slang; literally, "shaking delirium" or "trembling madness" in Latin) is an acute episode of delirium that is usually caused by withdrawal or abstinence from alcohol following habitual excessive drinking, or benzodiazepines or barbiturates (and other minor tranquilizers).When caused by alcohol, it occurs only in individuals with a history of constant, long-term alcohol consumption. Occurrence due to benzodiazepine or barbiturate withdrawal does not require as long a period of consistent intake of such drugs. Prior use of both tranquilizers and alcohol can compound the symptoms, and while extremely rare, is the most dangerous especially if untreated. Barbiturates are generally accepted as being extremely dangerous, both due to overdose potential and addiction potential including the extreme withdrawal syndrome that usually is marked by delirium tremens upon discontinuation. Due to this, barbiturates are rarely used anymore, being replaced by the generally accepted less dangerous benzodiazepines, which however still cause a similar withdrawal syndrome. Five percent of acute ethanol withdrawal cases progress to delirium tremens.Unlike the withdrawal syndrome associated with opiate addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Xyz from Other Diseases
Epidemiology and Demographics
Five percent of acute ethanol withdrawal cases progress to delirium tremens. Unlike the withdrawal syndrome associated with opiate addiction (generally), delirium tremens (and alcohol withdrawal in general) can be fatal. Mortality can be up to 35% if untreated; if treated early, death rates range from 5-15%.
Risk Factors
Screening
Screening tools include the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE screening test.
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
To evaluate any electrolyte abnormalities causing electro physiological changes in the heart muscle.
X-ray
Echocardiography and Ultrasound
CT scan
A CT scan of the head should be performed to evaluate any intracranial pathology.
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Avoid or reduce the use of alcohol. Get prompt medical treatment for symptoms of alcohol withdrawal.