The syndrome that follows abrupt reduction of alcohol in a dependent person.
Key points
• Onset 6-12 hours: tremor, sweating and anxiety; seizures peak at around 24-48 hours.
• Delirium tremens at 48-72 hours - confusion, hallucinations and autonomic instability - is a medical emergency.
• Treat with a benzodiazepine regimen tailored to the patient's severity and risk, following local protocol (for example chlordiazepoxide where appropriate).
• Give parenteral thiamine before glucose to prevent Wernicke's encephalopathy.