Delirium Tremens - Causes, Symptoms, Diagnosis and Treatment

What Is Delirium?

Delirium is also called an acute confusional state, in which a person becomes confused, and disoriented over a short period, usually within hours to days. Typically it starts suddenly, and this sudden change in mental status could be reversed. All of these result in difficulty in paying attention, thinking, sleeping, and remembering things.

A person may experience delirium during severe or chronic illness, infection, alcohol withdrawal, certain medications, changes in metabolic balance, surgery, drug intoxication, or when there is dementia. Delirium is not permanent and can be treated effectively. In addition, delirium and dementia symptoms can be similar, so it might be difficult for the doctor to come to an accurate diagnosis. Initially, delirium occurs within hours or a few days.

What Are the Types of Delirium?

The delirium types are categorized based on the cause, severity, and other characteristics. They are:

1. Delirium Tremens - This is experienced in people who try to stop drinking and have been drinking alcohol constantly for so many years.

2. Hyperactive Delirium - People will be highly uncooperative and alert.

3. Hypoactive Delirium - This delirium type is more common. People with this delirium will not be attentive, sleep more, or be disorganized in their daily tasks. Also, they may miss their important appointments and daily meals.

4. Mixed Delirium - People with this type have a combination of hyperactive and hypoactive delirium, alternating between the two states.

What Are the Risk Factors?

• A previous history of alcohol withdrawal symptoms, such as seizures and DTs.

• Multiple instances of discontinuing significant alcohol consumption.

• Heavy alcohol consumption (the higher the intake, the greater the risk).

• Increasing age. It becomes simpler to develop DTs as age. Alcohol withdrawal and DTs are uncommon in those under 30.

• Other medical issues. These include nutritional inadequacies as well as various medical issues such as cardiovascular and liver illness.

What Are the Causes of Delirium?

Delirium occurs when the brain's regular to and fro signals are impaired. Brain function is interfered with or impaired due to many factors that combine to make it vulnerable and trigger the malfunctioning of the brain's activity. Those factors are listed below, and as already explained, delirium may have one or more causes, like a combination of drug toxicity with a medical condition.

• Fever and acute infection, especially in children.

• Pneumonia, urinary tract infection, or the flu, particularly in older adults.

• Drug toxicity and certain medications.

• Dehydration and malnutrition.

• Changes in metabolic balance (low calcium or low sodium).

• Alcohol withdrawal or drug intoxication.

• Pain.

• Severe or chronic illness.

• Certain medical conditions such as a heart attack, severe lung disease, liver damage or disease, stroke, or injury due to a fall or trauma.

• Sleep disturbances or severe emotional deprivation.

• Surgical procedures or other medical procedures that incorporate anesthesia.

• Exposure to toxins such as cyanide, carbon monoxide, or some other poisons.

What Are the Symptoms of Delirium?

Generally, the symptoms of delirium start over a few hours to days, and they most often fluctuate throughout the day. Occasionally there are periods of no symptoms, and when they occur, they tend to become worse at night (when it is dark and while looking at objects, it may seem less familiar to affected individuals). The symptoms of delirium are as follows;

Changes in Behavior and Thinking Skills:

• Unable to focus on a particular topic.

• Unable to switch to other topics.

• Do not respond to the questions asked or to a conversation.

• Being stuck with a single idea.

• Not able to respond to the environment.

• Not able to recognize the recent events.

• Not even able to recognize where they are or who they are.

• Imagining or seeing things that do not exist. (Medically called hallucinations).

Changes in Speech and Learning Skills:

• Restlessness

• Being quiet, particularly in older adults.

• Difficulty in reading, speaking, recalling words, and writing.

• Trouble understanding speech.

• Rambling speech.

• Difficulty in speaking.

• Poor memory.

Sleep Changes:

• Sleep disturbances.

• Change in the sleep cycle.

Emotional Changes:

• Anxiety.

• Slow movements.

• Depression.

• Fear.

• Irritability and anger.

• Unpredictable mood swings.

• The feeling of intense happiness.

• Lack of interest in anything.

How Is Delirium Diagnosed?

Based on the symptoms experienced, the doctor will make use of a technique called a confusion assessment method to check if the person can speak, think, and move normally. The doctors will continuously observe the person for the severity of the symptoms.

By using the confusion assessment method, it is possible to identify whether:

• The person's behavior changes between days, or within a day, mainly during hospitalization.

• A person is rambling.

• There is trouble thinking straight or paying proper attention while listening to others.

• The person can move around without any problems.

• There is a good memory power or can identify others.

Since the change in the chemical equilibrium of the brain is affected by many factors, the doctor needs to identify the exact cause behind delirium by making use of the required tests based on the patient's medical history and the symptoms. Some of the commonly used tests to check for chemical imbalances are:

• Thyroid test.

• Blood chemistry test.

• Head scans - brain imaging.

• Urine tests.

• Drug and alcohol test.

• Chest X-ray.

• Liver test.

Certain neurological tests can be done to check for any underlying health conditions. During these tests, vision, reflexes, coordination, and balance will be checked to determine whether any neurological disease is responsible for delirium.

What Are the Complications of Delirium?

Alcohol use disorders and DTs can both lead to a variety of problems, many of which are dangerous. They include:

• Nutritional problems, especially Wernicke-Korsakoff syndrome (an alcohol-induced B1 deficiency).

• Seizures.

• Anxiety and depression.

• Sleep problems.

• Heart and circulation disorders.

How Is Delirium Treated?

The first and foremost step in treating delirium is to identify any triggers or underlying health conditions that are responsible for the condition itself. These include withdrawal from certain medicines, metabolic imbalance, and any other infection. Then the treatment will focus on keeping the brain healing and a calm environment. This can be done by certain supportive care, which includes:

• Taking care of the airways.

• Consuming proper nutrition and fluids.

• Taking care of pain and infections.

• Getting help for movements.

• Avoiding major changes to the environment.

• If there is any incontinence, then address it immediately.

• Involving with others such as family members and friends.

Apart from these, medications can also help in managing delirium. The family members need to discuss with the doctors to check if there is any medicine that is causing the condition. The medicines will mainly be given for calming persons who are easily agitated by changes in the environment or hallucinate or fear the presence of other people.

How Soon After Treatment Will One Feel Better?

The major symptoms of delirium usually disappear within three to seven days. One should gradually feel better throughout that time. In severe circumstances, one may endure certain symptoms for weeks or months.

Is Delirium Tremens Preventable?

If one has an alcohol use disorder and wants to stop drinking, consult a healthcare specialist. One can assist in finding resources, care, and support that will allow you to safely limit alcohol consumption while also giving the best chance of success. One can propose alcohol treatment programs, specialized providers, support groups, and other resources. To avoid or lessen the risk of getting alcohol use disorder (including DTs), drink in moderation. This means drinking by the following guidelines:

• Men and persons assigned male at birth (AMAB) should have no more than two alcoholic drinks per day and no more than 14 per week.

• Women and persons assigned female at birth (AFAB) should limit their alcohol consumption to one per day and seven per week.

Conclusion:

If you are a caretaker, or if you are a family member of someone who is suffering from delirium, you can help them by taking small steps to improve the person’s health and prevent it from recurring again. Make sure there is no major change in their surroundings and encourage their activities. Ensure a quiet environment and help them have a regular schedule to boost the healing of the brain.