Delirium tremens: a severe alcohol withdrawal syndrome

Today we know one of the most extreme conditions associated with alcohol.

Throughout history, society has assimilated the consumption of alcoholic beverages, becoming a characteristic of some cultures.It has become a characteristic of some cultures. It is something that can be observed in parties, concerts and discotheques, traditions, as part of the leisure habits of young people and even in the popularity of phenomena like the botellones.

However, it must be taken into account that alcohol consumption can lead to addiction, with the drinker losing control of his or her intake, thus generating dependence on the substance. And this dependence is not only expressed through the abuse of the substance, but also through signs and symptoms that appear when alcohol consumption is stopped. Among the most serious phenomena of alcohol withdrawal are the following delirium tremens. Let us see what it consists of.

The mechanics of abstinence

Once a dependence has been generated, the withdrawal of the object to which one is dependent causes withdrawal syndrome, i.e. the absence of the substance in the body causes symptomatic reactions.In other words, the absence of the substance in the body causes symptomatic reactions. That is why in many cases ending alcoholism is not as simple as withdrawing the possibility of consuming this type of beverage once and for all. The lack of this substance also produces a series of symptoms that can sometimes be dangerous in themselves.

Generally, the opposite effect to that caused by the substance is produced, which means that in the case of a depressant substance (such as alcohol), manic-type symptoms will occur, while in the case of excitants, the withdrawal syndrome will consist of a drop in the general activity of the organism. In any case**, the withdrawal of the desired substance must be controlled**, as too abrupt a cessation of supply can cause these syndromes.

Among the withdrawal syndromes related to alcohol abuse, the most serious is considered to be the so-called delirium tremens.

What is delirium tremens?

Delirium tremens is the name given to the acute confusional symptoms produced by alcohol deprivation.. It is caused by the interruption of alcohol intake in chronic drinkers who have developed a physical dependence, and frequently appears after 4 to 72 hours of abstinence.

Although delirium tremens usually occurs in patients who stop drinking after excessive alcohol consumption, it is possible to find cases in which this syndrome has been caused by illness, trauma or infections in individuals with high alcohol consumption in the past.

Symptoms of delirium tremens

The main symptoms of this syndrome are a disintegration of consciousness in which visual hallucinations, delusions, emotional lability and stupor appear. visual hallucinations, delirium, emotional lability and stupor appear.. Tremors, psychomotor agitation and convulsions are also frequent.

Generally, delirium tremens has a short duration, but regardless of this it is a dangerous syndrome, since 20% of the cases are fatal in case of not receiving medical attention, and even with this 5% of the cases end in the patient's death.

Phases of delirium tremens

In the first phase, vegetative symptoms such as anxiety, tachycardia, dizziness, restlessness and insomnia, caused by a rise in noradrenaline in the blood, begin to be observed. If the second phase is reached, about 24 hours after onset, the intensity of the above symptoms increases, with uncontrollable tremors and intense sweating.. Convulsions may also appear.

Finally, in the third phase (defining delirium tremens), a state of altered consciousness called obnubilation appears. This is defined by a propensity to distractions and confusion, together with a profound disorientation. The most characteristic feature of this phase is the appearance of visual hallucinations (usually microzoopsias) and delusions, together with a heightened sense of distress. Agitation, tachypnea, hyperthermia and tachycardia are also present.

Possible treatments

Taking into account that delirium tremens is a problem that can lead to the patient's death, immediate hospitalization is required for those who present the symptoms described, and admission to the ICU may be necessary.

The basic objectives of treatment are to keep the patient alive, avoid complications and alleviate symptoms. Thus, the monitoring of the patient will be constant, observing his hydroelectric balance and vital signs.

Although the specific measures will depend on the case, the administration of diazepam, loracepam and dipotassium chloracepate to achieve patient sedation, water and electrolyte control in order to maintain hydration of the affected person and administration of vitamins to maintain the correct functionality of the organism are frequently applied. In addition, haloperidol haloperidol is also usually applied to control the psychotic process and hallucinations..

A final consideration

Although excessive alcohol consumption is a dangerous phenomenon, and those who stop drinking do so for good reasons, it is necessary for those who decide to stop drinking to take into account the physical dependence that their organism maintains with this substance.

It is essential in cases of addictions or long-term substance use (including medications such as tranquilizers or antidepressants) that the withdrawal of the substance be gradual, since in the initial stages the body needs a certain dose of the substance to continue to function properly.

In addition, it is worth remembering that the kind of health hazards associated with delirium tremens can be avoided by by detecting cases of alcohol addiction in time.This makes it possible to close the door to alcoholism in time. The use of this kind of beverages is socially very accepted and widespread in all kinds of contexts, and that is why detecting its first signs can be complicated, given the degree of normalization of the abuse of these substances.

To learn about some of the signs that indicate the presence of the beginnings of alcoholism, you can read this article: "The 8 signs of alcohol addiction".

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
• Correas, J.;Ramirez, A. & Chinchilla, A. (2003). Manual de Urgencias Psiquiátricas. Masson.
• Ferri, F.F. (2015). Delirium tremens. In: Ferri FF, ed. Ferri's Clinical Advisor. 1st ed. Philadelphia: PA Elsevier Mosby; p. 357.
• Golberg, D. & Murray, R. (2002). The Maudsley hanbook of practical psychiatry. Oxford.
• Marta, J. (2004). Practical approach to delirium. Masson.
• O'Connor, P.G.. (2016). Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; chap 33.