Delirium tremens is a constellation of signs and symptoms that include confusion, agitation, delirium, combativeness, hallucinations (commonly visual changes involving bright lights and color), and potential seizure activity. These responses put patients at risk for self-injury as well as injury to staff and others. Additionally, these patients exhibit surges of sympathetic output resulting in tachycardia, hypertension, profuse sweating, and mydriasis. Patients with concomitant cardiovascular disease are at risk for myocardial infarction, intracerebral hemorrhage, and stroke. Even with treatment, delirium tremens carries a mortality risk of approximately 10%.

One way to prevent delirium tremens is to have the patient continue alcohol consumption. While it is desirable to treat someone for alcoholism, abrupt cessation is not the answer in the acute hospitalization period when other medical or surgical concerns are paramount. If the patient is able to drink liquids or has an enteral feeding tube (e.g., nasogastric tube, orogastric tube, percutaneous endoscopic gastronomy tube) and there are no other contraindications to enteral feeding, the easiest way to prevent delirium tremens is simply to give the patient alcohol. Many hospitals stock beer or spirits either in their pharmacy or as part of their food service system and these may be prescribed for the patient deemed at risk of developing delirium tremens. Limited amounts will
suffice, generally one to two beers or the equivalent in spirits or wine (one 12-ounce beer is equal to 5.5 ounces of wine or 1.5 ounces of spirits such as vodka or whiskey assuming a proof of 80) with meals. This will not lead to overt intoxication, particularly in someone who normally consumes much larger amounts. Blood alcohol levels can be measured, however, if there is such a concern. If enteral feeding is not an option, ethanol can be infused intravenously. It is usually ordered as 10% ETOH to be run at a rate of 20 to 40 cc/hr. Like enteral alcohol, this in most cases will prevent withdrawal and delirium tremens without leading to overt intoxication.