Delirium tremens is a serious neurological consequence of alcohol withdrawal, that is, the abrupt cessation or drastic reduction of excessive and prolonged alcohol consumption. This complication essentially results in a confused and delusional state. Delirium tremens requires rapid and appropriate medical treatment because it can be life-threatening.

Definition of delirium tremens

This medical term is the association of the Latin term delirium, delirium, and tremens, tremor. Delirium tremens, or “trembling delirium”, seems to have been used for the first time at the beginning of the XNUMXth century by the physician Thomas Sutton. For a time, it was used to designate both the delusional state due to excessive alcohol consumption and that related to alcohol withdrawal. At the end of the XNUMXth century, the definition of delirium tremens was clarified. There is no longer any question of associating it with the consequences of excessive alcohol consumption. Delirium tremens is a complication of alcohol withdrawal. It is characterized by hyperactivity of the autonomic nervous system associated with confusion, disorientation, hallucinatory delirium and in some cases the occurrence of convulsive seizures.

Cause du delirium tremens

Delirium tremens is a consequence of alcohol withdrawal. To understand its origin, we have to go back to alcohol dependence. Excessive and / or chronic alcohol consumption leads to changes in the central nervous system. It is these changes that will cause dysfunction when alcohol consumption abruptly decreases or stops. They are at the origin of the symptoms of alcohol withdrawal and, in the most severe cases, of the manifestation of delirium tremens.

DIAGNOSTIC du delirium tremens

The diagnosis of delirium tremens essentially requires a clinical examination. As far as possible, it is supplemented by questioning the patient and relatives.

Beyond the diagnosis, medical examinations can be set up to assess and monitor the patient’s overall state of health:

• a blood count;
• a blood ionogram with the measurement of blood sugar and creatinine;
• a creatine phosphokinase assay;
• a hemostasis assessment;
• an electrocardiogram;
• a chest x-ray.

People affected by delirium tremens

Delirium tremens occurs in people with alcoholic withdrawal. It occurs particularly in subjects undergoing alcohol withdrawal without medical supervision. Support from a healthcare professional is essential to avoid complications.

Factors favoring delirium tremens

While uncontrolled alcohol withdrawal increases the risk of delirium tremens, other factors favoring this complication have been identified. These factors can be classified as follows:

• socio-demographic factors such as age over 40, burn injuries, the number of previous weanings, a history of delirium tremens, or definitive weaning crises;
• factors falling within the framework of the mode of consumption including in particular the quantity of alcohol consumed per day, late age for excessive consumption, tolerance and significant dependence, or excessive use of benzodiazepines or barbiturates;
• biological factors such as the presence of thrombocytopenia, anemia, hypokalaemia, hypoalbuminemia or even hypochloremia;
• clinical factors such as hypotension, increased heart or respiratory rate, or the presence of an infection.

Delirium tremens results in a set of symptoms. Some are typical of alcohol withdrawal while others are specific to delirium tremens.

Typical symptoms of alcohol withdrawal

Delirium tremens presents typical symptoms of withdrawal such as:

• nausea and / or vomiting;
• a change in vital parameters with hypertension, tachycardia, hyperthermia;
• tremors;
• restlessness and hyperarousal.

Specific symptoms of delirium tremens

Delirium tremens also results in more specific symptoms:

• a hallucinatory delirium with total adhesion of the person concerned, resulting in visual hallucinations with terrifying scenarios, auditory and cenesthetic hallucinations, etc. ;
• mental confusion with spatio-temporal disorientations, post-confusional amnesias, etc. ;
• neurological signs with an intense and generalized tremor of the body, disturbances of balance and sometimes seizures.

Duration of symptoms of delirium tremens

Delirium tremens usually appears 48 to 72 hours after the start of alcohol withdrawal. This state can last between 5 days to 2 weeks depending on the case and the treatment.

Management of delirium tremens typically includes:

• a sedative treatment which is mainly based on the use of benzodiazepines, and sometimes on the intake of barbiturates or propofol;
• intake of water, minerals and vitamins to correct hydro-electrolyte and vitamin disorders;
• medical surveillance supported by nursing care;
• correction of hyperthermia.

The prevention of delirium tremens relies above all on appropriate management of alcohol withdrawal. This must be done under medical supervision to limit the risk of complications.