D

delirium tremens A serious medical condition
that may develop during withdrawal from ALCOHOL
ADDICTION(ALCOHOLISM). The symptoms of delirium
tremens are both physical and psychologic; the
physical symptoms can be life threatening without
prompt medical treatment. Most people who
experience delirium tremens (also called DTs) are
long-term heavy drinkers who suddenly quit
drinking. However, delirium tremens may also
occur after a single episode of extreme alcohol
consumption in a person who does not often
drink heavily.
Delirium tremens develops as a consequence of
the BRAIN’s inability to restore the balance among
the neurotransmitters gamma-aminobutyric acid
(GABA), DOPAMINE, and glutamate. Instead the
imbalance that resulted from alcohol DEPENDENCE
spirals out of control, producing a spectrum of
autonomic dysfunctions that affect multiple body
systems.
Symptoms begin within a few to 48 hours of
alcohol cessation and are often severe from the
onset. Symptoms may include

• tremors and seizures


• hyperactive reflexes


• confusion, DELUSION, and HALLUCINATION


• anxiety, irritability, restlessness, and agitation


• tachycardia (rapid HEART RATE), TACHYPNEA(rapid
  BREATHING), diaphoresis (excessive sweating),
  and PALPITATIONS


• elevated body temperature and BLOOD PRESSURE


• NAUSEAand VOMITING

Diagnostic tests may include BLOOD tests to
measure blood alcohol concentration, LIVER
enzyme levels, and complete blood count (CBC).

The doctor may desire other tests to evaluate spe-

cific symptoms, such as ELECTROCARDIOGRAM(ECG)

for palpitations and tachycardia. Treatment is gen-

erally intravenous administration of BENZODI-

AZEPINES, such as chlordiazepoxide and diazepam,

to produce sedation and to help stabilize the NEU-

ROTRANSMITTERbalance in the brain because benzo-

diazepines also bind with GABA neuroreceptors.

Without treatment delirium tremens may so sig-

nificantly disrupt brain function as to cause death.

With appropriate and timely treatment, symptoms

end in about 72 hours and most people recover

completely in 7 to 10 days.

See also ALCOHOL HALLUCINOSIS; NALTREXONE; SUB-

STANCE ABUSE TREATMENT; WITHDRAWAL SYNDROME.

dependence The physiologic or psychologic

need to continue taking a particular DRUG. In

physiologic dependence, predictable changes occur

within the body that reconfigure or adapt a partic-

ular facet of function and result in the body’s

reliance on the substance to maintain that func-

tion. Often the body then reacts in unpleasant

ways (WITHDRAWAL SYNDROME) when the person

stops taking the substance. Physiologic depend-

ence ends when the body completely clears all

chemical traces of the drug. Drugs often subject to

abuse that cause physiologic dependence include

ALCOHOL, HEROIN, and opiate NARCOTICS such as

morphine, hydrocodone, and oxycodone.

In psychologic dependence taking the drug

results in pleasurable sensations and the desire

(craving, when intense) to take the substance to

obtain them. Though the drug causes chemical

changes in the body that result in temporary alter-

ations of function, the drug does not establish any

physiologic adaptation. Psychologic dependence

can be intense and does not correlate to the drug’s

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