Delayed-onset delirium tremens – a diagnostic and management challenge

Abstract

Delirium tremens (DT) is one of the most serious complications of alcohol withdrawal, affecting 5-10% of in-patients with a mortality rate up to 15%. DT, characterised by delirium and tremors, appears within 48-72 h of abstinence and persists for about 5-10 days. We report a case of DT in a young man with delayed onset on the 15th day after the cessation of alcohol use, despite an uncomplicated detoxification with benzodiazepine treatment. We hypothesise that the intake of country liquor in our patient, which contains higher percentages of alcohol, causes a prolonged imbalance of N-methyl-d-aspartic acid and glutamate receptor activity, leading to the picture of delayed-onset DT and that an atypical presentation at the time of admission and atypicality in early course are clinical pointers to the subsequent development of delayed-onset DT.