Skip to main content
Intended for healthcare professionals

Abstract

Delirium tremens (DT) is one of the most severe and potentially fatal manifestations of alcohol withdrawal syndrome most often found in individuals with a history of prolonged and heavy alcohol use who suddenly stop. Without prompt intervention, DT may lead to life-threatening complications such as seizures, cardiovascular collapse and autonomic dysfunctions. The importance of understanding DT extends beyond its acute neurological and psychiatric symptoms. From a forensic perspective, autopsy findings can reveal a cascade of underlying physiological derangements. We present an autopsy case report that illustrates the clinical and pathological features of DT, emphasising its rapid progression and the critical need for multidisciplinary intervention.

Get full access to this article

View all access and purchase options for this article.

References

1. Grover S, Ghosh A. Delirium tremens: assessment and management. J Clin Exp Hepatol 2018; 8: 460–470.
2. Bramness JG, Pandey S, Moe JS, et al. History of delirium tremens in AUD patients in treatment: relationship to AUD severity and other factors. Subst Abuse Rehabil 2022; 13: 65–72.
3. Kaye AD, Staser AN, McCollins TS, et al. Delirium tremens: a review of clinical studies. Cureus 2024; 16: e57601.
4. Khan A, Levy P, DeHorn S, et al. Predictors of mortality in patients with delirium tremens. Acad Emerg Med 2008; 15: 788–790.
5. Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: a systematic review. Ind Psychiatry J 2013; 22: 100–108.
6. Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med 2014; 371: 2109–2113.
7. Medscape. Delirium tremens (DTs): practice essentials, pathophysiology, etiology of delirium tremens, https://emedicine.medscape.com/article/166032-overview (2024, accessed 3 June 2025).
8. Denison H, Jern S, Jagenburg R, et al. ST-segment changes and catecholamine-related myocardial enzyme release during alcohol withdrawal. Alcohol Alcohol 1997; 32: 185–194.
9. Mirande MD, Kubac G, Nguyen AT. Acute inferior ST-elevation myocardial infarction due to delirium tremens: a case report. J Med Case Rep 2019; 13(1): 306.
10. Kato K, Lyon AR, Ghadri JR, et al. Takotsubo syndrome: aetiology, presentation and treatment. Heart 2017; 103: 1461–1469.
11. Liu M. Unusual complications of alcohol withdrawal. emDocs, https://www.emdocs.net/unusual-complications-of-alcohol-withdrawal/ (2018, accessed 3 June 2025).
12. Schwartzberg D, Shiroff A. Repetitive myocardial infarctions secondary to delirium tremens. Case Rep Crit Care 2014; 2014: 638493.
13. Band RM, Meena MC, Kandpal A, et al. Rapid death due to alcohol withdrawal syndrome: case report and review of literature. Asia Pac J Med Toxicol 2015; 4: 51–54.
14. Kaya M, Duran A, Erkuran MK, et al. Delirium tremens and cardiovascular collapse: a case report. SM J Case Rep 2016; 2: 1021.
15. Ali F, Vajipeyajula A, Raj S. The prevalence of delirium in patients with alcohol related disorders. Int J Life Sci Biotechnol Pharma Res 2023; 12: 620–622.
16. Sailas E, Fenton M. Seclusion and restraint for people with serious mental illnesses. Cochrane Database Syst Rev 2000; 2: CD001163.
17. Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164: 1405–1412.
18. Baby S, Murthy P, Thennarasu K, et al. Comparative outcome in patients with delirium tremens receiving care in emergency services only versus those receiving comprehensive inpatient care. Indian J Psychiatry 2017; 59: 293–299.
19. Ministry of Health and Family Welfare, Government of India. Management of alcohol dependence: quick reference guide. Standard Treatment Guidelines, https://clinicalestablishments.mohfw.gov.in/sites/default/files/standard-treatment-guidelines/8291.pdf (2016, accessed 30 December 2025).