Delirium Tremens (DTs) Differential Diagnoses

Updated: Aug 04, 2021
  • Author: Shannon Toohey, MD, MAEd; Chief Editor: David A Kaufman, MD  more...
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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

  • Pellagrous encephalopathy - Niacin deficiency, causing pellagra; can be seen in persons who are homeless, are malnourished, have AIDS, or have chronic alcoholism; can present as an isolated acute delirium, without dermatitis or diarrhea, and has been mistaken for alcohol withdrawal

Differential Diagnoses