A 38-year-old chronic alcoholic is admitted for elective surgery. He is given diazepam 20 mg TDS for alcohol withdrawal prophylaxis. On day 3, he becomes confused, disoriented, febrile (38.2°C), grossly tremulous, and develops vivid visual hallucinations of insects crawling on him. He then has a generalised tonic-clonic seizure. This clinical picture is consistent with:
- A Delirium tremens ✓
- B Alcohol hallucinosis
- C Wernicke's encephalopathy
- D Benzodiazepine overdose
Explanation
Delirium tremens (DTs) is the most severe form of alcohol withdrawal, typically occurring 48–96 hours after the last drink (or reduction). It is characterised by: delirium (confusion, disorientation), autonomic hyperactivity (fever, tachycardia, diaphoresis, hypertension), tremulousness, and vivid (often visual) hallucinations — the 'classic' image is visual hallucinations of small animals or insects ('Lilliputian hallucinations'). Seizures may precede DTs. DTs carry 5–15% untreated mortality. Alcohol hallucinosis is auditory without delirium and occurs earlier (12–24h). Wernicke's presents with the triad of confusion, ophthalmoplegia, and ataxia without hallucinations primarily.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.