Delirium Tremens (DTs) Differential Diagnoses
- Author: Michael James Burns, MD, FACEP, FACP; Chief Editor: Michael R Pinsky, MD, CM, FCCP, FCCM more...
Diagnostic Considerations
The signs of alcohol withdrawal in critically ill patients, especially if accompanied by delirium, may mimic those of other serious disorders. These disorders may need to be excluded before a firm diagnosis of alcohol withdrawal is made.
Conditions to consider in the differential diagnosis of alcohol withdrawal include the following:
- Sepsis
- Stroke
- Intracranial hemorrhage
- Meningitis
- Hepatic encephalopathy
- Hypoxia
- Opioid abuse
- Uremia
- Wernicke encephalopathy
- Anxiety
- Epidural and subdural infections
- Herpes simplex encephalitis
- Hypocalcemia
- Hypomagnesemia
- Brain neoplasms
- Neuroleptic malignant syndrome
- Pheochromocytoma
- Status epilepticus
- Amphetamine toxicity
- Hallucinogen toxicity
- Cocaine toxicity
- Heroin toxicity
- Monoamine oxidase inhibitor toxicity
- Phencyclidine toxicity
- Sympathomimetic toxicity
- Thyroid hormone toxicity
- Acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection
- Cerebral embolism
- Cerebral hemorrhage
- Cerebral tumors
- Encephalitis
- Hypoxia
- Raised intracranial pressure
- Substance intoxication and withdrawal
- Toxic ingestions or exposures (eg, methanol, salicylates, ethylene glycol, carbon monoxide, anticholinergics)
- Vitamin B-12 deficiency
- Thyrotoxicosis
Differential Diagnoses
- Acute Liver Failure
- Alcoholic Ketoacidosis
- Brain Abscess
- Chronic Renal Failure
- Diabetic Ketoacidosis
- Encephalopathy, Hepatic
- Encephalopathy, Hypertensive
- Encephalopathy, Uremic
- Head Trauma
- Hypoglycemia
Chan GM, Hoffman RS, Gold JA, et al. Racial variations in the incidence of severe alcohol withdrawal. J Med Toxicol. Mar 2009;5(1):8-14. [Medline].
Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. Nov 1989;84(11):1353-7. [Medline].
Krishel S, SaFranek D, Clark RF. Intravenous vitamins for alcoholics in the emergency department: a review. J Emerg Med. May-Jun 1998;16(3):419-24. [Medline].
[Guideline] Gold JA, Rimal B, Nolan A, Nelson LS. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. Mar 2007;35(3):724-30. [Medline].
Weinberg JA, Magnotti LJ, Fischer PE, et al. Comparison of intravenous ethanol versus diazepam for alcohol withdrawal prophylaxis in the trauma ICU: results of a randomized trial. J Trauma. Jan 2008;64(1):99-104. [Medline].
McCowan C, Marik P. Refractory delirium tremens treated with propofol: a case series. Crit Care Med. Jun 2000;28(6):1781-4. [Medline].
Hendey GW, Dery RA, Barnes RL, Snowden B, Mentler P. A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal. Am J Emerg Med. May 2011;29(4):382-5. [Medline].
Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. Jul 12 2004;164(13):1405-12. [Medline].
Jaeger TM, Lohr RH, Pankratz VS. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin Proc. Jul 2001;76(7):695-701. [Medline].

