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What is Delirium Tremens? Symptoms, Stages & DT Treatment

Medical Providers:
Dr. Michael Vines, MD
Alex Spritzer, FNP, CARN-AP, PMHNP
Clinical Providers:
Natalie Foster, LPC-S, MS
Last Updated: December 31, 2025

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), approximately 27.9 million Americans ages 12 and older had alcohol use disorder in 2024. Of those who attempt to quit without medical supervision, an estimated 3-5% will develop delirium tremens, a condition that carries a mortality rate of up to 37% when left untreated.

But here’s what gives us hope every single day: with proper medical intervention and supervised detoxification, the survival rate for delirium tremens exceeds 95%. That’s why we’re so passionate about educating families and individuals about the warning signs, timeline, and treatment options for this life-threatening condition.

In this comprehensive guide, our medical team at The Hope House shares evidence-based information about delirium tremens, drawn from both current research and our years of clinical experience treating severe alcohol withdrawal in our Scottsdale detox facility.

Delirium Tremens Defined

Delirium tremens (DT) is a severe, life-threatening form of alcohol withdrawal syndrome characterized by sudden and severe mental and nervous system changes. The medical community recognizes DT as a psychiatric emergency requiring immediate hospitalization.

According to the American Academy of Family Physicians, delirium tremens represents Stage 3 of Alcohol Withdrawal Syndrome, the most severe stage that involves:

  • Profound confusion and altered consciousness (inability to think clearly, disorientation to time and place)
  • Autonomic hyperactivity (racing heart, high blood pressure, profuse sweating, fever)
  • Severe tremors (uncontrollable shaking, particularly of the hands)
  • Cardiovascular instability (risk of heart attack, stroke, or circulatory collapse)

The Reality of DT Mortality

Research published in the Journal of Addiction Medicine found that without medical treatment, delirium tremens has a mortality rate between 15-40%. However, with modern medical care in a supervised setting, this drops to less than 5%.

Delirium Tremens

How Much Do You Have to Drink to Get Delirium Tremens? 

Delirium tremens most often occurs after months or years of heavy daily drinking, such as 4–5 pints of wine, 7–8 beers, or a pint of liquor per day, especially in long-term dependence or past withdrawal history.

Symptoms of Delirium Tremens

Early recognition of DT symptoms can be lifesaving. Our medical team monitors patients around the clock for these warning signs, but it’s important for families to know what to watch for if a loved one is attempting to quit drinking.

Early Warning Signs (May Appear 6-24 Hours After Last Drink)

These symptoms, while uncomfortable, are not yet life-threatening but indicate the need for medical evaluation:

  • Anxiety, restlessness, or unexplained fear
  • Mild tremors (shaky hands)
  • Insomnia or disturbed sleep
  • Increased sensitivity to light, sound, or touch
  • Headache and mild confusion
  • Nausea or stomach upset

Severe DT Symptoms (Medical Emergency – Call 911)

If you observe these symptoms, this is a medical emergency requiring immediate hospitalization:

  • Severe confusion or delirium (not knowing where they are, who people are, or what day it is)
  • Vivid hallucinations (seeing, hearing, or feeling things that aren’t there – especially bugs or animals)
  • Seizures or convulsions (often generalized tonic-clonic seizures with loss of consciousness)
  • Severe agitation or combativeness (extreme restlessness, aggression)
  • High fever (above 101°F/38.3°C)
  • Rapid or irregular heartbeat (tachycardia, arrhythmia)
  • Profuse sweating (soaking through clothes)
  • Chest pain

Understanding Alcohol Withdrawal Seizures

Seizures represent one of the most dangerous complications of both alcohol withdrawal and delirium tremens. According to MedlinePlus, the most common type is generalized tonic-clonic seizures (formerly called grand mal seizures).

These seizures involve:

  • Loss of consciousness
  • Violent muscle contractions throughout the body
  • Possible loss of bladder/bowel control
  • Confusion and fatigue after the seizure ends

Important distinction: Seizures can occur with alcohol poisoning (after binge drinking) OR during withdrawal. Both require immediate medical attention, but the treatment approaches differ. Never assume you know which is happening, always call 911.

Can Delirium Tremens Cause Brain Damage? 

Delirium Tremens Timeline and Stages

Alcohol withdrawal follows a predictable pattern:

Stage 1: Mild Withdrawal (6-24 Hours After Last Drink)

Symptoms:

  • Anxiety and restlessness
  • Insomnia or difficulty sleeping
  • Headaches
  • Mild tremors
  • Stomach upset

What we do at The Hope House: Even during Stage 1, our medical team begins monitoring vital signs every 4 hours and administering medications to prevent progression to more severe stages.

Stage 2: Moderate Withdrawal (24-72 Hours After Last Drink)

Symptoms:

  • Increased sweating
  • Elevated heart rate and blood pressure
  • Nausea and vomiting
  • Confusion
  • Mild hallucinations (typically 12-24 hours after last drink)

What we do at The Hope House: We intensify monitoring to every 2 hours, administer IV fluids for hydration, provide anti-nausea medication, and adjust benzodiazepine dosing to keep symptoms controlled. This is the critical window where medical intervention prevents progression to Stage 3.

Stage 3: Severe Withdrawal – Delirium Tremens (48-96 Hours, Can Occur Up to 10 Days)

Symptoms:

  • Severe confusion and disorientation
  • Vivid hallucinations
  • Seizures
  • High fever
  • Rapid heartbeat
  • Severe agitation
  • Risk of cardiovascular collapse

Duration: DT symptoms typically last 2-3 days but can persist for up to 5 days in severe cases.

What we do at The Hope House: Patients showing signs of progressing to DT are immediately transferred to our hospital partners for intensive care unit (ICU) level monitoring. Our physicians work closely with hospital staff to ensure seamless care. We use high-dose benzodiazepines, continuous cardiac monitoring, IV fluids with vitamin supplementation (especially thiamine), and fever management protocols.

How Long Does Delirium Tremens Last? 

Typically, delirium tremens will last for about 2 days; however, in some cases, the problem can last as long as 5 days. 

Medical Treatment for Delirium Tremens at The Hope House

Historically, delirium tremens was treated as a psychiatric condition with straitjackets, padded rooms, and locked restraints. Modern addiction medicine recognizes DT as a medical emergency requiring evidence-based intervention.

Primary Treatment Goals

  • Prevent seizures through appropriate medication protocols
  • Control agitation to prevent self-harm and reduce cardiovascular stress
  • Stabilize vital signs (heart rate, blood pressure, temperature)
  • Reduce mortality risk through continuous monitoring and early intervention

Evidence-Based Medication Protocols

  • Benzodiazepines: The gold standard for alcohol withdrawal treatment. At The Hope House, we primarily use:
  • Lorazepam (Ativan): Preferred for patients with liver disease; intermediate duration of action
  • Diazepam (Valium): Longer-acting; good for preventing seizures
  • Chlordiazepoxide (Librium): Long-acting; often used in milder cases

Supportive Medications:

  • Thiamine (Vitamin B1): Prevents Wernicke-Korsakoff syndrome
  • Folic acid and multivitamins: Addresses malnutrition
  • Electrolyte replacement: Corrects imbalances
  • Anti-nausea medications: Ondansetron or promethazine
  • Beta-blockers: For heart rate control when appropriate

How To Get Rid of DTs? 

Essentially, for treating DT the ultimate goal is to watch, manage, and help the patient return to homeostasis. If symptoms begin to worsen, medical professionals will help stabilize the patient, but at this moment there is no get-healthy-quick cure for delirium tremens or alcohol addiction in general.

While there may be no “cure” for DT, there are ways to avoid the problem overall from the very beginning.

How to Avoid Delirium Tremens

Detox removes alcohol from your system, but it doesn’t address the underlying alcohol addiction. Research consistently shows that people who transition directly from detox into comprehensive treatment have significantly higher long-term success rates.

At The Hope House, we offer:

Safe Alcohol Detox Starts With the Right Support

Delirium tremens is one of the most dangerous complications of alcohol withdrawal, but it’s also one of the most preventable. With proper medical supervision, the right medications, and continuous monitoring, we can keep you safe through the entire detox process.

Whether you’re researching options for yourself or a loved one, The Hope House team is here to help. Our addiction specialists provide free, confidential consultations to help you understand your options and create a personalized treatment plan.

Don’t wait until withdrawal becomes life-threatening. Call us today to learn more about our alcohol rehabilitation programs in Arizona.

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