A person presents to OPD with tremors, visual hallucinations after 2 days history of alcohol cessation. Diagnosis is:
**Core Concept**
Delirium tremens (DTs) is a severe form of alcohol withdrawal characterized by tremors, visual hallucinations, and altered mental status. It occurs 48-96 hours after the last drink, with a peak incidence at 48-72 hours.
**Why the Correct Answer is Right**
The pathophysiology of DTs involves a sudden decrease in the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and an increase in the excitatory neurotransmitter glutamate. This imbalance leads to an overactivation of the central nervous system, causing the characteristic symptoms of DTs. The visual hallucinations are thought to be due to the intense stimulation of the brain's visual cortex.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not accurately describe the presentation of DTs. While seizures can occur in alcohol withdrawal, they are not the hallmark symptom of DTs.
**Option B:** This option is incorrect because it is a symptom of DTs, not a diagnosis. The correct diagnosis is delirium tremens.
**Option C:** This option is incorrect because it is a different condition altogether. Wernicke's encephalopathy is a condition caused by thiamine deficiency, characterized by ataxia, ophthalmoplegia, and confusion.
**Clinical Pearl / High-Yield Fact**
Delirium tremens is a medical emergency that requires prompt treatment with benzodiazepines, such as lorazepam or diazepam. The "rule of 5s" can be remembered: 5 days of drinking, 5 drinks per day, and 5 years of heavy drinking increase the risk of developing DTs.
**Correct Answer: C. Wernicke's encephalopathy**