Question:medium
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 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
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Think about the timing -- symptoms appearing 48-96 hours after stopping alcohol point to a specific withdrawal syndrome.
Updated On: Jun 23, 2026
- Wernicke's Encephalopathy
- Korsakoff's psychosis
- Hangover
- Delirium Tremens
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The Correct Option is D
Solution and Explanation
Approach via withdrawal timeline:
In alcohol dependence, abrupt cessation triggers a well-defined sequence of withdrawal phenomena. The timing of symptom onset after the last drink is the key diagnostic discriminator:
In alcohol dependence, abrupt cessation triggers a well-defined sequence of withdrawal phenomena. The timing of symptom onset after the last drink is the key diagnostic discriminator:
- 0-6 hours: Minor withdrawal (tremor, anxiety, nausea, insomnia)
- 12-24 hours: Alcoholic hallucinosis (perceptual disturbances with clear sensorium)
- 24-48 hours: Withdrawal seizures (grand mal, self-limited)
- 48-96 hours: Delirium Tremens -- the most severe stage
Why Delirium Tremens fits this case:
This patient stopped alcohol 3 days ago ($72$ hours) and now presents with agitation, altered sensorium (global confusion), paranoid delusions, and hallucinations. This is the classic DT presentation combining severe autonomic instability with florid psychosis.
This patient stopped alcohol 3 days ago ($72$ hours) and now presents with agitation, altered sensorium (global confusion), paranoid delusions, and hallucinations. This is the classic DT presentation combining severe autonomic instability with florid psychosis.
Why the other options are wrong:
Wernicke's encephalopathy = ophthalmoplegia + ataxia + confusion (thiamine deficiency, not cessation timing-dependent). Korsakoff's psychosis = chronic anterograde amnesia + confabulation (late sequela, no acute agitation). Hangover = mild, self-limiting, resolves in <24 hours with no psychosis.
Wernicke's encephalopathy = ophthalmoplegia + ataxia + confusion (thiamine deficiency, not cessation timing-dependent). Korsakoff's psychosis = chronic anterograde amnesia + confabulation (late sequela, no acute agitation). Hangover = mild, self-limiting, resolves in <24 hours with no psychosis.
Management of DT: Benzodiazepines (diazepam/lorazepam) are the cornerstone; thiamine supplementation is always co-administered.
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