Guide to Delirium Tremens: Causes, Symptoms, & Treatment

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Medically Reviewed By: Diana Vo, LMFT

October 20, 2023

Table of Contents

Delirium tremens (DTs) is the most severe form of alcohol withdrawal syndrome and can lead to problems such as cardiovascular collapse, seizure, coma, and even death.

Today, we’ll double down on what you can expect if you encounter DTS while withdrawing from alcohol and how treatment at a Huntington beach rehab and sober living home can help you conquer this alcohol abuse and stop your alcohol intake. But before we do that we need to start with a delirium tremens definition.

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Delirium tremens (DTs) is the most dangerous case of ethanol withdrawal caused by the abrupt cessation of excessive alcohol use among those with alcohol use disorders. DT manifests itself as complete mental confusion, hyperactivity, which can metastasize itself as full cardiovascular collapse. Often minor withdrawals from alcohol include tremors, severe dehydration, anxiety, nausea, vomiting, and insomnia, whereas major alcohol withdrawal symptoms are characterized by risk factors such as visual and auditory hallucinations, violent tremors, autonomic hyperactivity, vomiting, and hypertension.

Data shows that roughly half of those people abusing alcohol will experience some form of alcohol withdrawal symptoms when they stop drinking. Of these, 5% will present symptoms of delirium tremens which can lead to potentially fatal consequences.

Delirium tremens typically manifests in people with a history of sustained and chronic alcohol abuse. DTs are also more common in those who have experienced more severe alcohol withdrawal symptoms in the past. DTs usually manifest after periods of heavy drinking.

Is Delirium Tremens a Medical Emergency?

Delirium tremens might be rare, but the condition can also be potentially life-threatening. 

The symptoms of delirium tremens differ from the standard symptoms of alcohol withdrawal syndrome, and the DTs also unfold over a different timeline. If your healthcare provider suspects delirium tremens, they will perform a physical exam, looking for symptoms like heavy sweating, an irregular heartbeat, respiratory failure, and rapid muscle tremors.

What Happens During Delirium Tremens?

What happens during delirium tremors is often extremely dangerous for individuals quitting alcohol.  Symptoms include nightmares, agitation, global confusion, disorientation, hallucinations, tactile hallucinations, fever, high blood pressure, heavy sweating, Often times the onset of symptoms may appear quickly but typically last two to three days after quitting of heavy drinking, being most excruciating on the fourth or fifth day.

A man sits with his arms resting on his knees window to represent severe alcohol withdrawal.

Cause of DTs

What is the delirium tremens cause, then? 

Well, delirium tremens usually occur when someone who has been drinking heavily stops drinking or dramatically reduces their intake of alcohol. CDC defines heavy drinking as more than 15 weekly drinks for men or 8 weekly drinks for women. 

Alcohol is a CNS depressant, meaning that it slows the central nervous system when it enters the body. Chronic and long-term abuse of alcohol can cause changes to the structure and function of the brain. When alcohol is removed from the equation, your brain continues operating in its altered state. This imbalance leads to the symptoms of alcohol withdrawal. 

Your risk factor for delirium tremens is increased in the following circumstances: 

  • If you have been drinking alcohol long-term
  • If you have previously experienced alcohol withdrawal syndrome
  • If you have previously experienced delirium tremens
  • If you have a seizure disorder

So, now you are familiar with a basic definition of DTs, what kind of symptoms can you expect to encounter if this rare but potentially deadly form of alcohol withdrawal sets in?

Delirium Tremens Symptoms

The symptoms of delirium tremens typically manifest from 48 hours to 96 hours after the last drink.

In some cases, DT symptoms first appear 7 to 10 days after the last drink.

Once the delirium tremens symptoms appear, they can often rapidly get worse. 

The most common delirium tremens symptoms include: 

  • Irritability
  • Agitation
  • Body tremors
  • Hallucinations
  • Delirium
  • Deep sleep
  • Changes to mental function
  • Fear
  • Excitement
  • Spikes of energy
  • Rapid mood changes
  • Stupor
  • Sleepiness
  • Fatigue
  • Restlessness
  • Acute sensitivity to light

Of all these symptoms, delirium tremens hallucinations are perhaps the most disturbing.

Seizures can occur, and these can occur without any other delirium tremens symptoms developing. 

Most people affected by seizures find they occur during the 12 to 48 hours after the last drink. These are usually tonic-clonic seizures, and they are most common in those who have suffered past complications when undergoing the process of alcohol withdrawal.

Delirium Tremens Timeline

While the progress of delirium tremens tends to follow a general timeline, you may find some symptoms will fluctuate while others persist for much longer. 

To understand what happens with DTs, it pays to examine the overall timeline for alcohol withdrawal. This will help you to put delirium tremens into a sharper perspective. 

Alcohol withdrawal usually unfolds as follows, starting from 6 hours to 12 hours after your last drink:

Stage 1

From 6 to 12 hours after your last alcoholic drink, minor withdrawal symptoms set in, some of the common symptoms of acute alcohol withdrawal include: 

  • Sweating
  • Headache
  • Insomnia
  • Anxiety
  • Loss of appetite
  • Nausea
  • Increased heart rate
  • Irregular heart rate

Stage 2

From 12 to 24 hours after the last drink, some people experience hallucinations. These can include any or all of the following types of hallucinations: 

  • Auditory hallucinations: Hearing sounds that don’t exist
  • Tactile hallucinations: Feeling a sense of burning, itching, or numbness that is not actually occurring
  • Visual hallucinations: Seeing things that don’t exist

If you experience hallucinations during alcohol withdrawal, this seldom continues for more than 48 hours after the last drink.

Stage 3

Seizures induced by alcohol withdrawal usually occur from 24 to 48 hours after the last alcoholic drink.

Stage 4

Delirium tremens, the most severe manifestation of alcohol withdrawal, can occur from 48 to 72 hours after the last drink. 

Delirium tremens symptoms will usually peak within 5 days of beginning, and symptoms start to subside after 5 to 7 days. 

The more severe alcohol withdrawal symptoms of DTs like hallucinations and alcohol withdrawal seizures typically occur from 12 hours to 48 hours after the last drink. 

While most symptoms of delirium tremens should be resolved in 5 days, sometimes symptoms linger for up to 10 days.

How Much Do You Need To Drink to Get Delirium Tremens

If you have a history of drinking 7 to 8 US pints of beer, or 1 US pint of liquor daily, you are at heightened risk of developing DTs during withdrawal. 

Delirium Tremens Treatment

If you are at risk of severe alcohol withdrawal symptoms, it is strongly recommended that you engage in medical treatment before attempting to detox from alcohol. 

Treatment for delirium tremens will begin at the hospital, and the condition is treated as a medical emergency. You will require around-the-clock medical monitoring, and in some more severe cases of DTs, you may need treatment in an intensive care unit (ICU) while medical professionals treat delirium tremens. 

Not only can the symptoms of delirium tremens rapidly and suddenly worsen, but it can even be deadly. 

The primary goals of treatment are: 

  • Save the person’s life
  • Prevent complications
  • Relieve symptoms

Medications can be used to relieve some of the symptoms of DTs. 

  • Benzodiazepine: Benzos like Librium, Valium, and Ativan can all help to manage the symptoms of alcohol withdrawal, delirium tremens included. Benzos can also help reduce the risk of seizures. Large doses of benzodiazepines are required, and they will only be administered short term.
  • Antipsychotics: Low doses of antipsychotics like haloperidol can effectively manage some psychotic symptoms like hallucinations, while also helping you to think more clearly. This class of medication carries a high risk of adverse side effects, though.
  • Barbiturates: If benzos are not enough to manage the symptoms of DTs, barbiturates like phenobarbital may be effective.

The treatment team will check regularly for the following: 

  • Body fluid levels
  • Electrolyte levels
  • Blood pressure
  • Breathing rate
  • Pulse
  • Temperature

Medications will ensure you remain calm until the DTs are complete. 

Any long-term preventive treatment can begin after you have recovered from the symptoms of delirium tremens. This could include: 

  • Total lifelong avoidance of alcohol
  • Counseling
  • Psychotherapy
  • 12-step support groups like AA

You may also need to seek treatment for any of the following adverse outcomes: 

  • Wernicke-Korsakoff syndrome
  • Alcoholic neuropathy
  • Alcoholic liver disease
  • Alcoholic cardiomyopathy

While it is vital to receive medical treatment while experiencing the symptoms of DTs, symptoms can still progress and worsen once manifested. 

If you continue to drink alcohol after detoxing, you will be more likely to experience DTs in the future.

How Do You Prevent Delirium Tremens?

The only surefire way of preventing delirium tremens is to abstain from drinking alcohol or to drink in line with sensible dietary guidelines (2 daily drinks for men, and 1 daily drink for women). 

If you consume large amounts of alcohol and you believe you could be at risk of developing severe withdrawal symptoms like DT when you stop alcohol consumption. You should speak with a medical professional before abruptly stopping drinking as you may be at risk of developing delirium tremens.

Delirium Tremens FAQs

When Do Delirium Tremens Start?

Delirium tremens (DTs) is a severe form of alcohol withdrawal that can occur 2 to 4 days after someone stops drinking alcohol. However, in some cases, DTs can occur up to 10 days after someone stops drinking.

How Long Does Delirium Tremens Last?

Delirium tremens symptoms will usually peak within 5 days of beginning, and symptoms start to subside after 5 to 7 days. 

Can You Die From Delirium Tremens?

Yes, DTs can be fatal. In fact, 37% of people who don’t get appropriate treatment die from this problem. The most common causes of death in people with DTs are heart attack, stroke, and seizures.

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Overcome Late Stage Alcohol Withdrawal at Renaissance Recovery

Here at Renaissance Recovery, we can help you address alcohol addiction, however severe, and can provide assistance to help treat alcohol withdrawal. 

For anyone with a chronic and long-term problem with alcohol abuse, medical detox is vital. With around-the-clock medical supervision, the detox and withdrawal phase is made as comfortable as possible. You’ll have access to FDA-approved medications to soothe the intensity of withdrawal symptoms, while also minimizing your cravings for alcohol. You will also have access to a range of other medications to help counter symptoms of nausea, insomnia, anxiety, and depression as you withdraw in a controlled setting. 

Detox and withdrawal set the foundation for recovery proper to begin. Our evidence-based outpatient programs can help you move beyond alcohol use disorder. You’ll benefit from medication-assisted treatment delivered in combination with counseling, psychotherapy, and holistic therapy to give you a whole-body approach to recovery. 

For anyone suffering from co-occurring mental disorders like depression or anxiety, our dual diagnosis treatment program allows you to unpack both conditions simultaneously for the strongest chance of sustained recovery during substance abuse treatment.

For anyone looking to overcome alcohol addiction or alcohol dependence, all you need to do is contact Renaissance Recovery today.



At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.

Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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