Topic: Delirium Tremens Subject: Medicine You see a 49-year-old man in the emergency room with a 20-year-history of alcohol abuse. He is agitated and floridly psychotic, with visual hallucinations and persecutory delusions. On examination his blood pressure, heart rate and respiratory rate are all increased. He is disoriented, sweaty, and has abdominal cramps. What is the most likely diagnosis?
A. Subdural hematoma
B. Alcohol intoxication
C. Hepatic encephalopathy
D. Delirium tremens
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Correct Answer : D.
Delirium tremens (DTs), a very serious set of symptoms, may result if alcohol withdrawal is left untreated. Delirium tremens usually does not begin immediately; rather, it appears about 2 to 10 days after the drinking stops. In delirium tremens, the person is initially anxious and later develops increasing confusion, sleeplessness, nightmares, excessive sweating, and profound depression. The pulse rate tends to speed up. Fever typically develops. The episode may escalate to include fleeting hallucinations, illusions that arouse fear and restlessness, and disorientation with visual hallucinations that may incite terror. Objects seen in dim light may be particularly terrifying, and the person becomes extremely confused. The floor may seem to move, the walls fall, or the room rotates. As the delirium progresses, the hands develop a persistent tremor that sometimes extends to the head and body, and most people become severely uncoordinated. Delirium tremens can be fatal, particularly when untreated.