If your brain has adjusted to your heavy drinking habits, it takes time for your brain to adjust back. Alcohol withdrawal symptoms occur in a predictable pattern after your last alcohol drink. Not all symptoms develop in all patients:
Tremors (shakes) — These usually begin within 5 to 10 hours after the last alcohol drink and typically peak at 24 to 48 hours. Along with tremors (trembling), you can have a rapid pulse, an increase in blood pressure, rapid breathing, sweating, nausea and vomiting, anxiety or a hyper-alert state, irritability, nightmares or vivid dreams, and insomnia.
Alcohol hallucinosis — This symptom usually begins within 12 to 24 hours after your last drink, and may last as long as 2 days once it begins. If this happens, you hallucinate (see or feel things that are not real). It is common for people who are withdrawing from alcohol to see multiple small, similar, moving objects. Sometimes the vision is perceived to be crawling insects or falling coins. It is possible for an alcohol withdrawal hallucination to be a very detailed and imaginative vision.
Alcohol withdrawal seizures — Seizures may occur 6 to 48 hours after the last drink, and it is common for several seizures to occur over several hours. The risk peaks at 24 hours.
Delirium tremens — Delirium tremens commonly begins two to three days after the last alcohol drink, but it may be delayed more than a week. Its peak intensity is usually four to five days after the last drink. This condition causes dangerous shifts in your breathing, your circulation and your temperature control. It can cause your heart to race dangerously or can cause your blood pressure to increase dramatically, and it can cause dangerous dehydration. Delirium tremens also can temporarily reduce the amount of blood flow to your brain. Symptoms can include confusion, disorientation, stupor or loss of consciousness, nervous or angry behavior, irrational beliefs, soaking sweats, sleep disturbances and hallucinations.