A 30 -year - old male with history of alcohol abuse for 15 years is brought to the hospital emergency with 'complaints of fearfulness, misrecognition, talking of self, aggressive behavior, tremulousness and seeing snakes and reptiles that are not visible to others around him. There is history of last drinking alcohol 2 days prior to the onset of the present complains. He is most likely suffering from:
The onset of symptoms is after 2 days of last intake. There is history of chronic alcohol use. There is history of disorientation (mis-recognition), visual hallucination (seeing snakes and reptiles), and hyperactivity. All these put together is suggestive of delirium tremens. DELIRIUM TREMENS (DTs) It is the most severe form of alcohol withdrawal syndrome. Untreated DTs has a moality rate of 20% Essential feature: Delirium occuring within 1 week of last alcohol drink Clinical features are as follows: Clouding of consciousness with disorientation to time and place Poor attention and distractibility Visual hallucination and illusions which are often vivid and very frightening Autonomic disturbanceslike tachycardia, fever, hypeension, sweating and pupillary dilatation Psychomotor agitation and ataxia Treatment: Benzodiazepines- Chlordiazepoxide if LFT is normal and Lorazepam if LFT is abnormal Parenteral Thiamine
Delirium tremens
Alcoholic hallucinosis
Schizophrenia
Seizure disorder
Substance Related and Addictive Disorders