A 50-year-old man with a 20-year history of heavy alcohol use abruptly stops drinking. He presents to the emergency department 4 days later with severe confusion, agitation, visual hallucinations of insects crawling on walls, coarse tremor, tachycardia (HR 120/min), and hyperthermia (38.8°C). The most likely diagnosis is:

• A Alcohol hallucinosis
• B Wernicke's encephalopathy
• C Delirium tremens ✓
• D Alcohol withdrawal seizure

Explanation

Delirium tremens typically occurs 48-96 hours after the last drink and is characterized by altered sensorium, agitation, autonomic hyperactivity (tachycardia, hyperthermia), and vivid visual hallucinations. Alcohol hallucinosis occurs within 24-48 hours with intact sensorium and no autonomic instability, which distinguishes it from delirium tremens.

Reference: Harrison's Principles of Internal Medicine, 20th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.