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Delirium Tremens (DTs)

Last Updated: September 22, 2023

Delirium tremens is a severe, sometimes fatal symptom of alcohol withdrawal that causes sudden and extreme changes in your nervous system and mental state.

Delirium tremens (DTs) is a severe symptom of alcohol withdrawal that is very dangerous, especially if untreated. Delirium tremens is typically only experienced by those who have used alcohol heavily over a prolonged period and carries a high fatality risk. This condition makes alcohol withdrawal the most dangerous type of withdrawal someone can go through.

What Is Delirium Tremens?

Delirium tremens is a severe form of alcohol withdrawal that causes sudden and extreme changes in your nervous system and mental state. As the name indicates, people experiencing delirium tremens often become delirious and detached from reality. Tremors, hallucinations, seizures and changes in vital signs may also occur. Dangerous changes in vital signs can lead to life-threatening symptoms.


Heavy, persistent alcohol use suppresses your nervous system. When alcohol consumption suddenly stops, your nervous system can become overactive and easily irritated. This irritation of the nervous system is what ultimately causes delirium tremens. Because of this, alcohol withdrawal is the leading cause of delirium tremens.

However, delirium tremens may occur during times other than alcohol withdrawal. Conditions that affect the nervous system, such as infection, head injury or poor nutrition, can potentially cause delirium tremens in someone who drinks alcohol heavily, even if they continue to drink.

How Much Alcohol Causes Delirium Tremens?

No specific amount of alcohol or duration of alcohol use causes delirium tremens. This complication of alcohol withdrawal is somewhat unpredictable. Research indicates that drinking an average of 20 drinks or more daily correlates significantly with a higher risk of delirium tremens. However, someone who drinks less than this can still get delirium tremens.

Risk Factors

Delirium tremens occurs more often in people who have previously experienced some form of alcohol withdrawal. People who drink excessively for more than 10 years or consume excessive amounts of wine, beer or liquor daily for several months are more likely to experience delirium tremens than others who heavily drink sporadically. Some main risk factors for delirium tremens include:

  • History of seizures during alcohol withdrawal
  • History of delirium tremens
  • Being ill during alcohol withdrawal
  • Severe initial withdrawal symptoms
  • Prior detox
  • Older age
  • Low potassium levels
  • Brain injuries or lesions

Ultimately, the risk of delirium tremens correlates most with the amount and frequency of alcohol use.

Symptoms of Delirium Tremens

Many symptoms associated with alcohol withdrawal and delirium tremens range in severity. Some signs of delirium tremens may include:

Mental/behavioral symptoms:

  • Becoming delirious
  • Sudden confusion
  • Decreased mental capacity
  • Aggression or irritability
  • Fearful attitude and/or excitement
  • Hallucinations
  • Rapid mood changes
  • Anxiousness
  • Depression

Physical symptoms:

  • Shaking or tremors
  • Rapid energy changes
  • Restlessness
  • Increased sensitivity to sound, light or touch
  • Tiredness
  • Headaches
  • Nausea
  • Vomiting
  • Changes in appetite
  • Changes in sleeping patterns
  • Pale, clammy skin
  • Sweating
  • Fever
  • Body aches

How Long Does Delirium Tremens Last?

Delirium tremens symptoms typically begin 36–72 hours after the last drink of alcohol. The duration of delirium tremens differs significantly, typically lasting between one and six days. Rare circumstances have occurred where delirium tremens has lasted considerably longer, with instances as long as 28 days.

Risks of Severe Alcohol Withdrawal

Alcohol withdrawal is the most serious type of substance withdrawal that someone can undergo. It is more severe than heroin or cocaine withdrawal. The neurological effects that alcohol withdrawal can create, including delirium tremens or seizures, can be deadly.

Someone experiencing severe alcohol withdrawal symptoms should immediately seek medical help by calling 911 in the U.S. for emergency services. Rapid medical intervention may be necessary to save someone’s life when they are experiencing severe alcohol withdrawal.

Can You Die From Delirium Tremens?

Delirium tremens can be fatal. Even with treatment, delirium tremens has a 5% fatality rate. Before the development of treatments for delirium tremens, over one-third of people who experienced this condition died. Going through delirium tremens without medical support still has a fatality rate of over one-third.

Treatment for Delirium Tremens

Treating delirium tremens typically involves two main components: using medications to calm the brain and treating symptoms that develop. Benzodiazepines are generally used to help relax the brain and treat the underlying cause of delirium tremens. Other medications and therapies can help calm restlessness, reduce body temperature, slow heart rate or treat other symptoms as they develop.

Pharmaceutical Options

Medical options can make a difference when facing alcohol withdrawal. Some commonly used pharmaceuticals include:

  • Benzodiazepines: Sedatives that act on similar receptors to alcohol and are frequently used to treat seizures, anxiety and insomnia.
  • Adrenergic Medications: Medications that regulate the nervous system and, thus, target elevated pulse and blood pressure.
  • Antiseizure Medications: Medicines that suppress seizures but do not address the underlying cause of delirium tremens.

Medical Detox

Medical detox is almost always recommended for someone who may develop or has delirium tremens. Medical detox is supervised by healthcare professionals who can quickly treat complications as they occur. Medical detox enables rapid intervention when life-threatening symptoms of delirium tremens begin.


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FAQs About DTs

What are other names for delirium tremens?

Delirium tremens is often abbreviated as DTs and has been called alcohol withdrawal delirium. It can also be more broadly categorized as an alcohol withdrawal symptom.

When does delirium tremens occur?

Delirium tremens most frequently happens when individuals engage in heavy drinking and alter their behavior.

Delirium tremens symptoms often manifesttwo to three days after the last drink, although they can appear as late as a week. The peaked intensity can be expected around four to five days after the last alcoholic beverage. Symptoms will generally dissipate withinnine days of the last drink.

Who can develop delirium tremens?

Delirium tremens often occurs in people with an alcohol use disorder who have been struggling with addiction for over 10 years. However, DTs can also occur after consistent heavy drinking that does not span such an extended time range.

What is it like to experience delirium tremens?

Delirium tremens causes confusion, and periods of the experience are not likely to be remembered. Hallucinations often occur and typically cause severe fear. Someone with delirium tremens is likely to experience things that are not there and become agitated or even aggressive, not recognizing those around them.

Can other disorders or diseases be co-current?

Delirium tremens can often be complicated by co-current problems that disguise the issue of delirium tremens. This can lead to worsened outcomes of delirium tremens and other medical conditions. Potential concurrent diseases may include:


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