Delirium tremens (DTs) is a severe form of acute alcohol withdrawal that is differentiated from other forms of alcohol withdrawal by its key clinical features, which include marked confusion, hallucinations, severe autonomic hyperactivity (such as tachycardia, hypertension, and fever), and agitation. These symptoms are more intense and life-threatening compared to the typical withdrawal symptoms like tremor, anxiety, sweating, and mild confusion seen in less severe withdrawal.
DTs usually develop 48 to 72 hours after cessation or reduction of heavy and prolonged alcohol use and represent a medical emergency requiring hospital admission and specific treatment, such as oral or parenteral lorazepam or haloperidol if symptoms persist or oral medication is declined.
In contrast, other forms of alcohol withdrawal may present with milder symptoms and do not typically include the profound delirium and autonomic instability characteristic of DTs.
Therefore, the key differentiating clinical features of delirium tremens are the presence of severe delirium (confusion and hallucinations), marked autonomic disturbance, and the timing of onset during withdrawal, which necessitate urgent medical intervention.
References: NICE CG100