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Delirium Tremens

Delirium Tremens or DT is a serious condition of alcohol withdrawal syndrome. DT leads to sudden and severe mental and nervous system changes.


Causes of Delirium Tremens

When a person suddenly stops drinking alcohol after a period of heavy consumption, and does not eat enough food, delirium tremens occurs. This means, a person consuming 4-5 pints of wine or 7-8 pints of beer of a pint of hard alcohol every day for several months. This could happen to people with more than a decade of drinking alcohol.

One important reason is that in long term drinkers, alcohol interferes with body's ability to regulate a neurotransmitter called GABA. In chronic alcohol abuse, the body mistakes alcohol for GABA and reacts to this by reducing its production of the neurotransmitter. As alcohol levels falls too low, it means there is not enough GABA for proper functioning. This can also occur due to infection, injury and illness in people with a history of heavy alcohol use and abuse.


Signs and symptoms of Delirium Tremens

Symptoms normally occur within 72 hours of the last drink, but they can also occur up to 10 days after the last drink. Common symptoms include:


  • Body tremors
  • Functional changes
  • Agitation
  • Anger and irritability
  • Confusion and loss of focus
  • Reduced attention span
  • Deep sleep that lasts for a day or longer
  • Excitement and fear
  • Hallucination
  • Hyperactivity
  • Quick mood reversals
  • Restlessness
  • Sensitivity to light, sound and touch
  • Sleeplessness and fatigue.

There could be seizures, most commonly in the first 12-48 hours after the last drink. As DT can temporarily reduce the amount of blood flow to the brain, symptoms as confusion, disorientation, stupor and loss of consciousness and hallucinations occur. There are other medical complications that can arise due to alcohol abuse. These include:


  • Alcoholic liver disease
  • Cardiomyopathy
  • Neuropathy
  • Blood clotting disorders
  • Wernicke Korsakoff's syndrome, a brain disorder due to thiamine deficiency
  • Injury from fall during seizures
  • Irregular heartbeat which can be life threatening
  • Delirium and injury to self/others in a state of confusion

The body goes through change due to withdrawal of alcohol when a person suddenly stops drinking after prolonged use. Alcohol has a slowing and sedating effect on the brain and the brain of a long term drinker is conditionally exposed to the depressant effect of alcohol. The brain starts producing naturally stimulating chemicals to compensate for the effect of alcohol. Hence, if the alcohol is withdrawn suddenly, the brain is lost. This dangerous condition of delirium tremens occurs in almost 1 out of every 20 persons. In this condition the brain is unable to read the chemistry after alcohol is stopped and therefore creates a temporary confusion leading to dangerous changes in the way the brain regulates body circulation and breathing. This creates risk of heart attack, stroke and death.


Diagnosis of DT

Blood tests can be done to assess blood magnesium and blood phosphate levels. Comprehensive metabolic panel and toxicology tests are also conducted. A stay in hospital in required for treatment. Regular checks of blood chemistry levels, such as electrolytes, body fluids level and vital signs such as temperature, pulse, breathing rate and blood pressure are monitored. Medications such as anticonvulsants, central nervous system depressants and sedatives are administered for symptoms such as seizures and irregular heartbeat. Sometimes the patient is put in a state of sedation for a week until withdrawal is complete. Benzodiazepine medications are given to treat seizures, anxiety and tremors. Only after the patient recovers from immediate symptoms is long term preventive treatment given. The doctor allows a ‘drying out' period in which no alcohol is consumed.

Hemorrhage

Hemorrhage refers to loss of blood from a person. Internal Hemorrhage happens when blood vessels rupture and lead to blood leakage. External Hemorrhage is a situation where a person loses copious amount of blood externally. This can happen from a natural body orifice or through a cut in the skin.


Hemorrhage locations

Hematuria: Loss of blood in the urine.

Hematemesis: Loss of blood in vomit.

Brain hemorrhage: Bleeding in the skull, brain tissue or rupture within the blood vessels in the head.

Gynecological hemorrhage: Bleeding through the vagina or ovaries.

A person can also experience upper gastrointestinal bleeding, pulmonary hemorrhage or rectal hemorrhage. Hemorrhage can occur due to high blood pressure, blood clotting disorders, uncontrolled diabetes or leukemia.


Blood Clotting

Blood clotting occurs due to a complex process of coagulation that heals a bleeding blood vessel with at clot. Blood platelets and plasma protein fibrinogen are vital to the blood clotting process. People can suffer from various blood clotting disorders such as formation of blood clots due to excessive blood clotting. The PT or Prothrombin Time Blood Test is done before any surgery to check a patient's bleeding and clotting factors. PTT or Partial Thromboplastin Time Blood Test checks for a clotting disorder.


Blood clots

Blood clots can form in the heart or legs or brain or even in the lungs. These clots can travel through the blood vessels and hamper the flow of blood. This can lead to damage in the organs. Blood clot in the veins of the arm or legs can lead to DVT or Deep Venous Thrombosis. Pulmonary embolism is a condition where a blood clot travels to the lungs. Blood clots during pregnancy can lead to miscarriage or pre eclampsia.


Excessive bleeding

Bleeding disorders can occur due to severe liver disease. Hemophilia is an inherited bleeding disorder. Bleeding disorders can also be a side effect of medicines.

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Bibliography / Reference

Collection of Pages - Last revised Date: September 23, 2019