Question

A 50 year old male suddenly stopped alcohol consumption for 3 days in hospital with agitation, altered sensorium, paranoid delusions and hallucinations. The most likely diagnosis is

• A. Wernicke's Encephalopathy
• B. Korsakoff's psychosis
• C. Hangover
• D. Delirium Tremens

Hint:

Think about the timing -- symptoms appearing 48-96 hours after stopping alcohol point to a specific withdrawal syndrome.

Answer 1

The Correct Option is D

Step 1: Identify the clinical context.
The patient is a 50-year-old male who suddenly stopped alcohol after chronic heavy use. Symptoms appeared 3 days after cessation. This timing is critical -- delirium tremens (DT) typically manifests 48-96 hours after the last drink.

Step 2: Analyse the symptom cluster.
The triad of findings here is: agitation and altered sensorium (global confusion), paranoid delusions, and hallucinations (visual and auditory). This represents a combined picture of autonomic hyperactivity (sympathetic overdrive) and psychotic features, which is the hallmark of Delirium Tremens.

Step 3: Eliminate the distractors.
Wernicke's Encephalopathy presents with the classic triad of ophthalmoplegia, ataxia, and confusion -- caused by thiamine deficiency, not acute cessation. Korsakoff's psychosis is a chronic amnestic syndrome with confabulation following untreated Wernicke's; it does not cause acute agitation or hallucinations on cessation. Hangover occurs within hours of drinking and resolves within 24 hours; it does not involve psychosis or global confusion.

Conclusion: Delirium Tremens is the most severe form of ethanol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse. The correct answer is D. Delirium Tremens.