eMedicine Specialties > Emergency Medicine > Neurology

Delirium Tremens: Differential Diagnoses & Workup

Author: Anne Yim, MD, Resident Physician, Department of Emergency Medicine, Kings County Hospital and State University of New York Downstate Medical Center
Coauthor(s): Sage W Wiener, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate, Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Oct 6, 2009

Differential Diagnoses

Acute Liver Failure
Neuroleptic Malignant Syndrome
Alcoholic Ketoacidosis
Pheochromocytoma
Anxiety
Psychosis
Brain Abscess
Status Epilepticus
Encephalopathy, Hepatic
Thyrotoxicosis
Encephalopathy, Hypertensive
Toxicity, Amphetamine
Encephalopathy, Uremic
Toxicity, Cocaine
Epidural and Subdural Infections
Toxicity, Hallucinogen
Head Trauma
Toxicity, Monoamine Oxidase Inhibitor
Herpes Simplex Encephalitis
Toxicity, Phencyclidine
Hypocalcemia
Toxicity, Sympathomimetic
Hypoglycemia
Toxicity, Thyroid Hormone
Hypomagnesemia
Wernicke Encephalopathy
Meningitis
Withdrawal Syndromes
Neoplasms, Brain

Workup

Laboratory Studies

  • Serum chemistry including the following:
    • Sodium
    • Potassium
    • Chloride
    • Bicarbonate
    • BUN
    • Creatinine
    • Glucose
    • Magnesium
    • Phosphate
    • Liver function tests
    • Creatine phosphokinase (Some patients develop rhabdomyolysis.)
    • Lipase
    • Ketones
  • Serum ethanol concentration – This is important because patients who exhibit withdrawal while ethanol is still present in the serum are likely to have a more severe course.
  • Complete blood count with differential
  • Urinalysis
  • Blood cultures
  • Further laboratory studies as indicated by clinical scenario

Imaging Studies

  • Chest radiography
    • About 50% of patients with delirium tremens who present with fever will have an infection; pneumonia being most common.
    • A chest radiograph should be obtained in all patients suspected of having delirium tremens.
  • Obtain cervical spine radiographs if any question or suspicion of trauma or head injury exists.
  • CT scanning of the head is performed selectively. Indications for a head CT scan include the following:
    • New-onset seizure
    • Seizures occurring over longer than a 6-hour period
    • More than 6 seizures
    • Focal seizures
    • Evidence of head trauma
    • Focal neurologic deficits
    • A prolonged postictal state
    • Deteriorating level of consciousness or failure to improve in level of consciousness over time

Procedures

More on Delirium Tremens

Overview: Delirium Tremens
Differential Diagnoses & Workup: Delirium Tremens
Treatment & Medication: Delirium Tremens
Follow-up: Delirium Tremens
References
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References

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Further Reading

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Keywords

DT, delirium tremens, delirium tremens symptoms, alcohol withdrawal delirium, alcohol withdrawal hallucinosis, ethanol abstinence, rum fits, ethanol withdrawal, ethanol alcohol withdrawal, ethanol withdrawal seizures

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Contributor Information and Disclosures

Author

Anne Yim, MD, Resident Physician, Department of Emergency Medicine, Kings County Hospital and State University of New York Downstate Medical Center
Anne Yim, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate, Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center
Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

William K Chiang, MD, Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center
William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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