Delirium Tremens: Severe Alcohol Withdrawal Seizures

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Delirium tremens, commonly abbreviated to DTs, is the severest form of alcohol withdrawal that can be fatal if untreated.

What Is Delirium Tremens?

Research indicates that approximately half of those who quit drinking alcohol experience alcohol withdrawal symptoms during detox, with around 5% of those people experiencing DTs

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Delirium tremens present almost exclusively in those with a history of chronic alcohol abuse. Delirium tremens also occurs more frequently among individuals with past presentations of severe withdrawal symptoms during detoxification. 

Oftentimes, DTs manifest in the aftermath of a prolonged period of heavy drinking

The symptoms of delirium tremens vary from those that present during alcohol withdrawal and unfold over a different timeline. The withdrawal symptoms associated with alcohol detox progress gradually, in some cases developing into DTs. 

Delirium Tremens Symptoms

In most cases, delirium tremens has a similar presentation and a similar timeline. Some symptoms of delirium tremens are short-lived while others linger for longer. 

Look out for the following symptoms of DTs: 

  • Rapid muscle tremors
  • Nausea
  • Vomiting
  • Excessive perspiration
  • Irregular heartbeat
  • Seizures
An image of a woman who is experiencing symptoms delirium tremens

How long does delirium tremens last, then?

To illustrate what happens in the event of delirium tremens, we’ll outline a standard alcohol withdrawal timeline. This will enable you to place DTs in perspective on a broader timeline. 

Most alcohol withdrawal symptoms first present from six to twelve hours after your last alcoholic drink. Symptoms can be categorized in four distinct stages, although not everyone will experience all stages or symptoms of withdrawal. 

Alcohol withdrawal: stage 1

The first symptoms of alcohol withdrawal are relatively mild and include:

  • Vomiting
  • Nausea
  • Appetite loss
  • Headaches
  • Irregular heart rate
  • Increased heart rate
  • Sweating
  • Insomnia
  • Anxiety

Alcohol withdrawal: stage 2

Some people detoxing from alcohol will experience hallucinations during the first 24 hours of sobriety. If hallucinations occur, they should subside within 48 hours of your last alcoholic drink.

Alcohol withdrawal: stage 3

If seizures accompany alcohol detox, these usually occur during the first two days after your last alcoholic drink. 

Alcohol withdrawal: stage 4

At any stage on the second or third day of alcohol withdrawal, the symptoms of DTs can manifest.

Delirium tremens symptoms will typically peak after five days, dissipating after about a week.

Delirium Tremens Symptoms

For most people who experience delirium tremens, the symptoms appear and subside within the first 96 hours of sobriety. 

Rarely, the symptoms of DTs only manifest after a week or so of sobriety. 

When the symptoms of delirium tremens present, they usually worsen quite quickly. 

Standard DTs symptoms are as follows: 

  • Rapid mood changes
  • Fatigue
  • Sleepiness
  • Restlessness
  • Hallucinations
  • Delirium
  • Tremors
  • Stupor
  • Heightened sensitivity to light
  • Spikes in energy levels
  • Fear
  • Excitement
  • Irritability
  • Agitation
  • Altered cognitive functioning

Seizures are one of the most severe and potentially life-threatening symptoms of DTs. Sometimes, seizures can occur without the presentation of any other delirium tremens symptoms. 

Seizures associated with delirium tremens are grand-mal seizures that occur more frequently in those with a history of unsuccessful alcohol withdrawal attempts. 

Perhaps the most distressing and aggravating symptoms of delirium tremens, hallucinations can take on the following forms: 

  • Visual hallucinations: You see things that are not real.
  • Tactile hallucinations: You feel a sense of burning, itching, or numbness that is not real.
  • Auditory hallucinations: You hear sounds that are not real.

DT Treatment

Delirium tremens treatment has three core goals: 

  1. Alleviating symptoms.
  2. Preventing complications.
  3. Safeguarding against life-threatening symptoms.

If you feel you are liable to experience severe alcohol withdrawal, you should strongly consider seeking medical treatment instead of relying on a home detox. 

Choosing to engage with alcohol withdrawal treatment at a medical detox center, inpatient rehab facility, or hospital means treatment for DTs can begin under close medical supervision. Delirium tremens requires close medical monitoring and needs to be treated as a medical emergency. Your treatment team will monitor the following: 

  • Temperature
  • Blood pressure
  • Breathing rate
  • Pulse
  • Body fluid levels
  • Electrolyte levels


The following delirium tremens medication can be effective for reducing the intensity of some symptoms, including: 

  • Benzodiazepines: Benzos like Librium and Valium can help with the management of all alcohol withdrawal symptoms, including delirium tremens symptoms. Benzodiazepines can also reduce your risk profile for seizures. Large dosages of benzodiazepines prescribed short-term can help streamline severe alcohol withdrawal.
  • Antipsychotics: If prescribed in low doses, antipsychotics like haloperidol can help alleviate psychotic symptoms such as hallucinations. Regrettably, antipsychotics carry a strong risk of triggering deleterious side effects.
  • Barbiturates: Barbiturates such as phenobarbital may prove effective if benzodiazepines are ineffective.

These medications can help to keep you calm and stable until delirium tremens symptoms subside, normally by the end of week one of alcohol detox.

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Alcohol Rehab at California Detox

At California Detox, we offer a variety of treatment programs for alcohol use disorder at all levels of care on American Society of Addiction Medicine’s continuum of care as follows: 

  • OP (standard outpatient program)
  • IOP (intensive outpatient program)
  • Virtual IOP (remote therapy)
  • PHP (partial hospitalization program)
  • Inpatient rehab (residential rehab) 
  • Dual diagnosis treatment (integrated treatment of addiction and mental health conditions)

Before engaging with a course of treatment for alcoholism, you must first detox. If you feel you are at risk of developing severe alcohol withdrawal symptoms and delirium tremens, inquire about our supervised medical detox. Take advantage of medications, clinical, and emotional care here at our licensed beachside medical detox center to ensure that alcohol withdrawal is as safe and comfortable as possible. 

All our programs draw from these evidence-based interventions: 

  • MAT (medication-assisted treatment)
  • Individual counseling
  • Group counseling
  • Psychotherapy (CBT or DBT)
  • Family therapy
  • Holistic therapies

Take the first crucial step toward sobriety by reaching out to admissions today at 949.567.8790.


The symptoms of alcohol withdrawal manifest during the first 24 hours of sobriety. The more severe symptoms like hallucinations and seizures typically appear from 12 hours to 48 hours after the last alcoholic drink, sometimes evolving into DTs.
The most effective method of avoiding delirium tremens is to avoid drinking alcohol. For those who choose to drink alcohol, adhering to dietary guidelines for moderate drinking will reduce your risk of developing severe withdrawal symptoms and delirium tremens if you discontinue or dramatically moderate alcohol use. . In the event of alcohol withdrawal symptoms presenting, prompt and effective treatment can reduce the risk of delirium tremens developing.


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