Delirium tremens

For the beverage, see Delirium Tremens (beer).

Delirium tremens (colloquially, the DTs or, "the shakes") is a condition nearly invariably associated with complete alcoholwithdrawal, although it also occurs as a complication of benzodiazepineand barbituratewithdrawal. It only occurs in individuals with a history of constant, long-term alcohol consumption. Delirium tremens typically manifests about 18 to 24 hours after discontinuation of alcohol consumption.

Five percent of acute ethanol withdrawal cases progress to delirium tremens[1]. Unlike the withdrawal syndrome associated with opiateor stimulantaddiction, delerium tremens (and alcohol withdrawn in general) can be fatal. Mortality can be up to 35% if untreated, though if treated early, death rates may be as low as 5%.

Symptoms

The symptoms include severe, uncontrollable tremorsof the extremities and intense hallucinations(eg, drawings on wallpaper that the patient would perceive as giant spiders ready to attack her or him). Unlike hallucinations associated with schizophrenia, delirium tremens hallucinations are primarily visual.

Causes

The exact pharmacology of ethanol is not fully understood, however it is theorized that delerium tremens is caused by the effect of alcohol on the benzodiazepine-GABAa-chloride receptor complex for the inhibitory neurotransmitter GABA. Constant consumption of alcoholic beveragesdown-regulates these receptors; when alcohol is no longer consumed, there are not as many receptors for GABA to bind to.

As GABA normally inhibits action potentialformation, fewer receptors mean that sympatheticactivation is unopposed.

It is possible that psychological(i.e., non-physical) factors also play a role.

Treatment

Treatment is symptomatic and supportive. Typically the patient is kept sedated with benzodiazepines, such as diazepam(Valium) or oxazepam(Serax) until symptoms subside. If status epilepticusis present, seizuresare treated accordingly.

See also

• Alcoholism
• Withdrawal
• Cold Turkey

External links

• Medline Encyclopedia: Delirium Tremens
• eMedicine Delirium Tremensda:Delirium tremens

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This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Delirium+tremens Wikipedia article Delirium tremens.