Delirium Tremens

Treatment

This is an emergency condition. The goals of treatment are saving the patient's life, treating the immediate symptoms, and preventing complications. Long-term preventive treatment may begin after initial treatment of the acute condition. Hospitalization is required. Vital signs (temperature, pulse, rate of breathing, blood pressure), and fluid and electrolyte status are monitored, and abnormalities are treated as appropriate.

Seizures and cardiovascular conditions, such as heart arrhythmias, are treated as appropriate. This may include lifesaving or life-support measures, anticonvulsant medications such as phenytoin, or other medications. Clonidine may reduce cardiovascular symptoms, and helps reduce anxiety. Central nervous system depressants and sedatives may be required, often in large doses, to reduce symptoms.

Treatment may require maintenance of a sedated state for a week or more until withdrawal is complete. Benzodiazepine medications such as diazepam are often useful to provide sedation. Diazepam is also useful to treat seizures as well as anxiety and tremors.

Hallucinations are treated similarly to any acute psychotic episode, with hospitalization as needed. Cautious use of antipsychotic medications, such as haloperidol, may be necessary in some cases.

A "drying out" period may be appropriate. No alcohol is allowed during this time. Treatment for alcohol use or alcoholism is recommended. This may include psychologic interventions, social supports such as AA (Alcoholics Anonymous), behavior modification, or other interventions.

Testing and treatment for other medical problems associated with use of alcohol is necessary. This may include disorders such as alcoholic liver disease, blood clotting disorders, alcoholic neuropathy, heart disorders (such as alcoholic cardiomyopathy), chronic brain syndromes (such as Wernicke-Korsakoff syndrome).