When should I consider referring a patient with delirium tremens to secondary care for further management?

Consider referring a patient with delirium tremens to secondary care for further management if they are in acute alcohol withdrawal and at high risk of developing delirium tremens or seizures, or if delirium tremens develops during treatment. Admission to hospital is recommended for medically assisted alcohol withdrawal in these cases. Delirium tremens requires treatment with oral lorazepam as first-line therapy, and if symptoms persist or oral medication is declined, parenteral lorazepam or haloperidol should be offered, which typically necessitates secondary care management.

Additionally, vulnerable patients (such as those who are frail, have cognitive impairment, multiple comorbidities, or lack social support) should have a lower threshold for hospital admission.