Delirium Tremens (DTs)

In simple terms, Delirium Tremens or DTs is a severe form of alcohol withdrawal. It usually affects people who stop drinking suddenly after a prolonged period of heavy drinking, especially if they are not accustomed to eating enough food with their drinks.

DTs alcohol withdrawal involves sudden changes in the nervous system or mental state. It is also commonly known as Alcohol Withdrawal Delirium or AWD. Further, DTs can also be caused by an injury to the head or illness in people with a history of heavy alcohol use.

Usually, patients start observing the symptoms of Delirium Tremens within 48-96 hours after their last drink. These symptoms can deteriorate quickly, and the patient might require urgent medical attention.

Here are some symptoms of DTs:

Symptoms of alcohol withdrawal

• Patients who have suddenly stopped drinking alcohol after prolonged and heavy use

• Tremor of the tongue, eyelids, or outstretched arms

• Sweating

• Nausea or vomiting

• Hypertension

• Psychomotor hyperactivity

• Headache

• Insomnia

• Malaise or weakness

• Hallucinations or illusions

• Seizures

• Anxiety

Symptoms of delirium

The strongest symptom is that the patient will not be aware of the environment and find it difficult to focus or pay attention

• Inability to display cognition

• Psychomotor disturbances

• Either oversleeping or undersleeping

• Symptoms that keep fluctuating throughout the day

Some patients also get seizures with or without the symptoms mentioned above. They usually occur within the first two days of the last drink. Also, seizures are more common among people with a history of alcohol withdrawal.

When you drink alcohol, it slows down your brain’s functioning by changing the inhibitory and excitatory mechanisms of the nervous system to provide a sense of sedation and decreased anxiety.

With continued use of alcohol, your system with compensate for the constant presence of alcohol by changing the way these two mechanisms work. Over time, you will have to consume more alcohol to feel ‘normal’.

After drinking constantly and heavily for many years, the system faces severe withdrawal when you suddenly stop drinking. This results in the development of Delirium Tremens.

Risk factors resulting in Delirium Tremens

Here is a quick look at some of the risk factors that can result in Delirium Tremens:

• An excessive amount of alcohol in the system in the days preceding the withdrawal

• People with multiple episodes of alcohol withdrawal

• People who have tried quitting alcohol before and have gone through the withdrawal symptoms

• Underlying health issues like a traumatic brain injury, liver disease, heart disease, or any major injury

• People with certain psychiatric disorders

How much alcohol does one have to drink to get Delirium Tremens?

While there is no fixed answer to this question, it is believed that people with a history of heavy drinking for a prolonged period are at a higher risk of developing Delirium Tremens. So, if you drink every day for several months or years, you are at a higher risk of developing DTs.

Usually, doctors conduct tests based on the symptoms and medical history of the patient. The first step is usually a physical exam that includes checking for:

• Startle reflex

• Excessive sweating

• Heart rate

• Eye movement

• Muscle tremors

The health care provider might also conduct tests including (but not limited to):

Toxicology screen: to determine the level of alcohol in the system

Electrocardiogram (ECG): to measure the level of electrical activity in the heart and estimate the severity of the withdrawal

Comprehensive metabolic panel: to get an overview of the blood sugar levels, liver function, and kidney function

Electroencephalogram (EEG): to assess the electrical activity in the brain to estimate the severity of the withdrawal

Lumbar puncture test: if there is any suspicion of the existence of meningitis

Blood magnesium level: low blood magnesium levels usually indicate severe alcohol withdrawal

Blood phosphate level: low phosphate levels indicate alcoholism

The first thing that one needs to know about Delirium Tremens is that it is a life-threatening disease. Therefore, hospitals treat patients in the ICU with constant monitoring. Once the doctors establish the severity of the DTs, they create a treatment plan to relieve the patient of the symptoms, prevent complications, and save his life.

Some medications that can be used in the treatment are:

• Pain medicines

• Antipsychosis medicines

• Heart-related medicines (depending on the heart problems)

• Anticonvulsants

• Liver-related medicines (depending on the liver problems)

• Blood pressure medicines

If the patient is experiencing breathing problems, then he might be put on a ventilator to stabilise breathing and is closely monitored. Typically, the treatment for Delerium Tremens lasts for four-to-five days, and patients are discharged once the symptoms are managed. Doctors also ask patients to visit them regularly to check for any signs of relapse

Since Delerium Tremens is primarily caused due to the excessive consumption of alcohol over prolonged periods, if you are a regular drinker, you can reduce the risk of developing DTs by following these tips:

• Avoid drinking alcohol every day

• Do not consume alcohol on an empty stomach

• Ensure that you have a healthy diet

• Drink a lot of water

• Get enough sleep

Here are some factors that you need to keep in mind to understand DTs:

The severity of alcohol withdrawal

The severity of delirium

Assessment of other risk factors associated with chronic heavy use of alcohol

Overall assessment of the patient

The first thing that one needs to do is assess the pattern, quality, and duration of alcohol consumption. The type of alcohol will also impact the after-effects. Usually, Delerium Tremens develops after 2-3 days of having the last drink. Therefore, keeping track of the time since the last drink is important. If the patient has a history of alcohol withdrawal, the details should be kept handy and provided to the doctor if needed.

Further, if the patient was on certain drugs like Benzodiazepines used to treat anxiety disorders, insomnia, and seizures, suddenly stopping such medicines also has similar withdrawal symptoms. This information should also be kept on hand.

Assess alcohol withdrawal

Today, there are numerous clinical assessment tools to determine the extent of alcohol withdrawal experienced by the patient. While the doctor would offer a detailed explanation, it is important to understand that most of these instruments grade the patient’s withdrawal based on a range of physical and mental attributes. Here are some factors considered by these instruments to assess alcohol withdrawal:

Agitation

Anxiety

Auditory disturbances

Headache or a sensation of a band around the head

Nausea or vomiting

Paroxysmal sweats

Tactile disturbances

Tremors

Visual disturbances

They look at these factors based on somatic and mental symptoms:

Somatic Symptoms

Breathing rate (per min)

Diastolic blood pressure (mmHg)

Pulse rate per minute

Sweating

Temperature (C)

Tremor

Mental Symptoms

Agitation

Anxiety

Contact

Hallucinations (optical, acoustic and tactile)

Orientation (time, place. person, situation)

The decision to reduce or stop the consumption of alcohol should be a planned one. Talking to a medical professional and seeking advice can be a good start. Make sure that you keep an eye open for any symptoms to identify and treat DTs as early as possible.

Assess Delirium

Like alcohol withdrawal, there are many tests and instruments to help assess delirium in an individual. Most such instruments assess features of acute onset, inattention, disorganised thinking, and altered level of consciousness. Usually, delirium is diagnosed when patients demonstrate:

A distinct change in the patient's mental state. It can also keep fluctuating constantly;

Inability to pay attention to anything; and

Inability to think in a structured manner.

Assess risk factors and co-morbidities

One needs to look for symptoms of other health issues due to excessive drinking.

Complications related to heavy and prolonged drinking

As explained above, excessive use of alcohol can impact the nervous system. Over time, as your brain adapts to the constant presence of alcohol in the system, your body starts depending on it. Withdrawal symptoms are shown by your body when you suddenly stop consuming alcohol after a prolonged period of use. This can lead to the following complications:

**Alcoholic Cardiomyopathy – ACM or Alcoholic Cardiomyopathy is ventricular dilation and impaired cardiac function caused due to chronic alcohol use. The symptoms include congestive heart failure, including shortness of breath and nocturnal dyspnea.

**Wernicke-Korsakoff Syndrome – WKS or Wernicke-Korsakoff Syndrome is a memory and brain disorder linked to the excessive use of alcohol. It starts with Wernicke Encephalopathy and progresses into Korsakoff Syndrome. The main symptoms of WKS are confusion, ataxia, and visual problems.

**Alcohol-Related Liver Disease – ARLD or Alcohol-Related Liver Disease is also commonly known as Alcoholic Fatty Liver Disease. This can be caused by drinking large amounts of alcohol even for a few days. While a fatty liver is reversible, if left untreated, it can result in Alcoholic Hepatitis and Cirrhosis over time.

**Alcoholic Neuropathy – Excessive use of alcohol can damage the nerves by altering the levels of vitamins E, B6 and B12, thiamine, niacin, and folate. Its symptoms include tingling in the limbs, numbness, muscle spasms, movement disorders, etc.

Delerium Tremens is a life-threatening disease requiring immediate medical attention and even hospitalisation. This is caused due to the excessive use of alcohol over prolonged periods. Hence, most patients with Delirium Tremens also have other medical problems like heart or liver issues, breathing issues, etc.

The overall cost of treatment and hospitalisation can dent your finances. Therefore, it is advisable to look for a medical insurance policy that offers coverage for Delirium Tremens.

A comprehensive health insurance policy like the one offered by TATA AIG includes a range of benefits, including:

• Effective management of medical emergencies without worrying about the costs of hospitalisation and treatment

• Keeps your savings intact as you do not have to dip into your corpus for medical exigencies

• Protection against a range of lifestyle-related illnesses and diseases

• Tax deductions as per the terms prescribed under Section 80D of the Income Tax Act, 1961

Tata AIG offers one of the best health insurance policies with coverage for a range of diseases and illnesses. The process of buying a policy from us is simple and hassle-free.

To buy Delirium Tremens insurance online, complete the following steps:

Visit our official website and navigate to the Health Insurance page

Determine if you want an individual policy or a family policy and list the members who you want to be covered under it

Provide the information requested by the site

Click on ‘Get Plan’

We will display a range of plans based on the information provided

Choose the right plan according to your needs

Select the sum assured

We will display the premium based on your choices

For individual policies, compare plans and premium rates to find the best plan for your needs

Click on ‘Buy Now’

Answer the call from our representative and complete the process

You can also buy the policy offline by following the process mentioned below.

Offline purchase:

Visit the closest TATA AIG office

Discuss your requirement with the representative

Go through plans and decide the one that best suits your needs

Fill out the required forms and attach the necessary documents

Pay the fees

You will receive the policy documents via physical mail in a few days at your registered mailing address

Here is a list of documents needed to buy TATA AIG’s medical insurance plan:

• Proof of age

• ID proof

• Proof of residential address

• Proof of income

• Recent photographs

• Complete details about the history of any health-related issues

Every health insurance policy has a list of inclusions and exclusions. Before you go through the list, it is important to assess your requirements and the features you need for comprehensive coverage.

Here are some features offered by Tata AIG’s medical insurance policy offering coverage for Delirium Tremens:**

Detection Phase: As explained above, detecting Delirium Tremens early is important so that you can start the treatment early and avoid unnecessary complications. The diagnosis includes a range of tests to assess the extent of alcohol withdrawal and delirium.

Also, if you have developed any other health issues, then they need to be diagnosed too, so that the doctor can create a treatment plan accordingly. These tests can cost a lot.

Hospitalisation costs: Typically, patients diagnosed with Delirium Tremens require immediate hospitalisation in an ICU. Tata AIG’s medical insurance policy covers hospitalisation expenses, including consumable costs.

Post-hospitalisation expenses: Once a patient is treated for Delirium Tremens, the doctor usually recommends regular visits to check for signs of relapse. The patient might also have to undergo various tests to ensure that the illness is not returning. We cover these costs too

Second Opinion coverage: Many patients prefer to take a second opinion before starting the treatment to ensure there is no human error in the diagnosis. With Tata AIG, you get coverage for second opinion costs.

Sum Insured: With advancements in medical treatments, the costs of medical care have increased exponentially over the last few years. Hence, choosing a health insurance policy that offers an adequate sum insured to manage the overall costs of treatment of Delirium Tremens is important. Tata AIG endeavours to offer the best sum insured as per your requirement.

It is important to remember that most policies have cooling and waiting period clauses. Make sure that you understand these terms before signing the dotted line.

Every claim will require specific documents to approve a claim for the treatment of Delirium Tremens. Hence, make sure you know the documents and submit them in the format required.

Here is a general list of documents needed for filing the claim:

Claim Form: Insurers will require you to submit the claim form within a stipulated period of receiving treatment for Delirium Tremens. Typically, this period is around 30 days. Make sure you submit a filled and duly signed claim form or submit it online within this period.

Diagnosis reports: You might have to provide medical reports and the doctor’s report that indicates that you have been diagnosed with Delirium Tremens.

Hospitalization costs: Ensure that you keep all hospital bills and treatment documents, your medical history papers, investigation documents, and the hospital discharge document organised, as you might need them to get the claim approved.

While we offer cashless hospitalisation at a network hospital, it is prudent to keep a file with all these documents so that you can back up your claim if needed.

The premium that you pay for a health insurance policy is deductible from your taxable income under Section 80D of the Income Tax Act, 1961. The maximum deduction amount is based on the policyholder's age and dependents covered under the policy.

Here are the details of health insurance tax benefits:

Individual Health Insurance Policy

• If you are less than 60 years old, then the maximum tax deduction you can avail of in one financial year is ₹25,000

• If you are above 60 years of age, then the maximum tax deduction you can avail of in one financial year is ₹50,000

Family Health Insurance Policy including spouse and children but excluding your parents

• If all the insured members are less than 60 years old, then the maximum tax deduction you can avail of in one financial year is ₹25,000

• If you or your spouse is above 60 years of age, then the maximum tax deduction you can avail of in one financial year is ₹50,000

Family Health Insurance Policy including spouse, children, and parents

• If you and your spouse are less than 60 years old and your parents are less than 60 years old, then the maximum tax deduction you can avail of in one financial year is ₹25,000 for yourself and ₹25,000 for your parents – a total deduction of ₹50,000

• If you and your spouse are less than 60 years old but your parents are more than 60 years old, then the maximum tax deduction you can avail of in one financial year is Rs.25,000 for yourself and ₹50,000 for your parents – a total deduction of Rs.75,000

• If you and your spouse are more than 60 years old and your parents are more than 60 years old, then the maximum tax deduction you can avail of in one financial year is ₹50,000 for yourself and ₹50,000 for your parents – a total deduction of ₹1,00,000

• It is important to note that these deductions include ₹5000 per year for preventive health checkups.