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QUESTION
A fifty-year-old patient, who has been drinking all his life has a six-month history of kidney disease, which, after diagnosis, he stopped drinking. Saying he had Stage 3 Liver Disease, he recently and came in disoriented, unbalanced and fiesty . . . it reminded me of DTs. How long after stopping drinking can a person develop DTs (Delirium Tremens)?


ANSWER
Good question! There is a peak time period for withdrawal states to begin, and a range of times as well the classic alcohol withdrawal syndromes. The most common time of onset after abstinence has begun are:

• Alcohol Withdrawal Syndrome (AWS): autonomic overactivity such as sweating and rapid pulse, tremor, nausea and vomiting, anxiety, insomnia. May begin a few hours after stopping drinking, often reaches a peak the second day and is quite improved by day five.
  
• Hallucinosis: auditory, visual or tactile-skin-illusions with intact reality testing. Usually peaks around 48 hours in the presence of the AWS (above).
  
• Seizures: Again usually associated with AWS and peaking around 48 hours, however may occur several days later.
  
• Delirium Tremens (DTs): Generally begins as the AWS creshendos, rather than diminishes, around day 4 or 5. Along with an intensified AWS there must be (to make a diagnosis) a disturbance of consciousness and cognition (disorientation or memory loss) and often hallucinations. May, however, develop a few days later, and is frequently associated with a medical complication such as liver failure or pneumonia.

Your patient has both liver and kidney disease which might contribute to the onset of his delirium. If he met the above criteria for DTs he certainly was in a "delirium," but if he had not has a drink alcohol for 6 months, it was not a "withdrawal delerium" however which DTs is! My thinking is that your alcoholic patient had a delirium similar to DTs several months after his last drink, and that it was triggerd by a medical disorder unless he was also taking a sedative drug?

That alcoholism may predispose persons to delirium we have known for some time; a study in which I participated in at Mayo in 1966 showed that alcoholics were more likely than others to develop delirium after surgery whether they were actively drinking then or not!

Thank you for the interesting question!


Dr Bob



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Dr. Bob does not provide specific medical advice or a medical diagnosis for any particular condition described, nor verify the authenticity of any information described in the questions presented. Patients should always consult their physician to discuss any specific symptoms, conditions, or modes of therapy for any particular mental or physical difficulties, diseases or conditions.

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