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Alcohol withdrawal delirium — DGM MCQ

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HardDeliriumAlcohol withdrawal deliriumDGM

A 76-year-old man is tremulous and confused 48 hours after admission for a fall. He is sweating, hypertensive and seeing animals in the room. His daughter reports daily heavy alcohol use before admission. Current medicines include none documented. What is the most likely diagnosis?

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Correct answer: E — Alcohol withdrawal delirium

Tremor, autonomic overactivity, hallucinations and timing after cessation of heavy alcohol intake suggest alcohol withdrawal delirium. Lewy body dementia is chronic, hypothyroidism is not this acute, BPPV causes vertigo, and vascular dementia does not cause withdrawal physiology. Benzodiazepine-based withdrawal treatment is an exception to the usual avoidance of benzodiazepines in delirium.

Reference: NICE alcohol-use disorders guidance; NICE CG103