Alcohol Withdrawal Syndrome and Delirium Tremens Alcohol withdrawal syndrome typically occurs within 1-2 days of alcohol abstinence and is characterized by autonomic hyperactivity, tremors, insomnia, nausea and vomiting, transient hallucinations, psychomotor agitation, anxiety, and tonic-clonic seizures. Symptoms may be mild for many patients, but if left untreated, it can lead to delirium tremens, an uncommon but severe and life-threatening manifestation of withdrawal marked by severe hallucinations, disorientation, and autonomic overactivity. Symptoms and signs include the following: Profoundly delirious state associated with tremulousness and agitation. Excessive motor activity (most notable as a tremor that affects the face, tongue, and extremities but that may also involve speech) and purposeless activity such as picking at the bedclothes. Hallucinations, classically visual rather than auditory, are a prominent feature. Autonomic nervous system hyperactivity: tachycardia, dilated pupils, fever, and hyperhidrosis. Loss of orientation as to time and place. Such patients are often oblivious to the most obvious features of the surrounding environment. Treatment Note temperature, pulse, and blood pressure, and record results twice hourly to monitor for hyperpyrexia and hypotension. Consider lumbar puncture to rule out meningitis if fever or meningismus is present. 1. FLUIDS Fluid requirements on the first day of treatment may be as if profound dehydration is present. Intravenous fluid should contain glucose to prevent hypoglycemia. 2. THIAMINE Thiamine, 100 mg/d, prevents Wernicke encephalopathy. 3. BENZODIAZEPINES Benzodiazepines are the primary form of treatment. They may also prevent patients with impending delirium tremens from developing a full-blown case.Drug of choice-Chlordiazepoxide a - Fatty liver- irrelevant b - Its abrupt withdrawal not gradual d - Small doses of alcohol consumption will not lead to raving. Therefore, a,b,d ruled out.