What is DT?

[ChronoTriggerMed]

First Aid Questions - Behavioral science

46. Are DT's life threatening?
Yes

Wut the heck is a DT?

[southpaw]

Delirium tremens (DT) is a potentially fatal form of ethanol (alcohol) withdrawal. Symptoms of ethanol withdrawal and DT have been recognized for hundreds of years, but the debate over their etiology continued into the 1950s. The work of Victor and Adams as well as Isbell finally demonstrated the symptoms related to ethanol abstinence.

Symptoms may begin a few hours after the cessation of ethanol, but may not peak until 48-72 hours. Emergency physicians must recognize that the presenting symptoms may not be severe and identify those at risk for developing DT. For patients in DT, early recognition and therapy are necessary to prevent significant morbidity and death.


Pathophysiology: DT is caused by the direct effect that ethanol has on the benzodiazepine-GABAa-chloride receptor complex. Persistent effects of ethanol lead to the down-regulation of the receptor complex. When ethanol is withdrawn, a functional decrease in the inhibitory neurotransmitter GABA is seen. This results in an unopposed increase in sympathetic activity with a resultant increase in plasma and urinary catecholamines. Ethanol also acts as an N-methyl D-aspartate receptor antagonist. Withdrawal of ethanol leads to increased activity of these excitatory neural receptors.


Frequency:
In the US: Only 5% of patients with ethanol withdrawal progress to DT.

Mortality/Morbidity:
Mortality rate may be as high as 35% if untreated but is less than 5% with early recognition and treatment.
Patients at greatest risk for death are those with extreme fever, fluid and electrolyte imbalance, or intercurrent illness such as pneumonia, hepatitis, or pancreatitis.

Sex: Approximately 10% of males and 3-5% of females are alcoholic; 5% of each group experiences DT.

Age: Adolescence to late adulthood is typical.