Clinical features

Delirium tremens is a severe withdrawal reaction in a patient who has drunk heavily for several years.

There may be a 24-hour prodromal period in which the patient may be apprehensive, experience mild disorientation, and may fit.

The features of delirium tremens are:

• delirium:
  • often worse at night
  • disorientation in time and place
  • clouding of consciousness
  • impairment of recent memory
  • agitation
    
    
• gross tremor of the hands
  
  
• sympathetic overactivity:
  • sweating
  • raised blood pressure
  • hypertension
  • pupil dilatation
    
    
• hallucinations/pseudohallucinations:
  • often visual, also aural
  • the content is often frightening
    
    
• dehydration and disturbed blood biochemistry:
  • leucocytosis
  • raised ESR
  • poor liver function tests

The patient usually is usually much improved after 36 hr.