Question:medium
A 55-year-old chronic alcoholic man presents with irrelevant talk, tremor, and sweating. He had his last drink 3 days ago. What is the probable diagnosis?
A 55-year-old chronic alcoholic man presents with irrelevant talk, tremor, and sweating. He had his last drink 3 days ago. What is the probable diagnosis?
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Confusion plus autonomic storm peaking 2-4 days after the last drink.
Updated On: Jun 24, 2026
- Delirium tremens
- Korsakoff psychosis
- Post-acute withdrawal syndrome
- Discontinuation syndrome
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The Correct Option is A
Solution and Explanation
Step 1: Build the timeline. The key data are heavy chronic drinking, abstinence for roughly three days, and now an acutely confused, tremulous, sweating patient. The 2 to 4 day window is the hallmark interval for the most dangerous withdrawal state.
Step 2: Apply the diagnosis. This picture, global confusion plus autonomic overdrive, is delirium tremens (alcohol withdrawal delirium), the gravest expression of ethanol withdrawal.
Step 3: Explain the neurochemistry. Long-term alcohol turns up $GABA$ inhibition and dampens $NMDA$ excitation. When the alcohol is removed, the brain is left under-inhibited and over-excited, generating tremor, sweating, fast heart rate, anxiety, and possibly seizures.
Step 4: Discard the alternatives. Korsakoff psychosis is a thiamine-deficiency memory disorder without acute autonomic storm; post-acute withdrawal and discontinuation syndromes lack the florid delirium seen here.
\[\boxed{\text{Delirium tremens}}\]
Step 2: Apply the diagnosis. This picture, global confusion plus autonomic overdrive, is delirium tremens (alcohol withdrawal delirium), the gravest expression of ethanol withdrawal.
Step 3: Explain the neurochemistry. Long-term alcohol turns up $GABA$ inhibition and dampens $NMDA$ excitation. When the alcohol is removed, the brain is left under-inhibited and over-excited, generating tremor, sweating, fast heart rate, anxiety, and possibly seizures.
Step 4: Discard the alternatives. Korsakoff psychosis is a thiamine-deficiency memory disorder without acute autonomic storm; post-acute withdrawal and discontinuation syndromes lack the florid delirium seen here.
\[\boxed{\text{Delirium tremens}}\]
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