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Alcohol withdrawal delirium — DGM MCQ

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HardDeliriumAlcohol withdrawal deliriumDGM

An 81-year-old man with alcohol dependence is admitted after a fall. Forty-eight hours later he is tremulous, sweating, hypertensive and sees insects on the wall. He is disorientated and his last drink was the morning of admission. What is the most likely diagnosis?

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Correct answer: C — Alcohol withdrawal delirium

Autonomic overactivity, tremor, visual hallucinations and timing after alcohol cessation indicate alcohol withdrawal delirium. Sepsis may also cause delirium, but the withdrawal signs and timing are more specific. Alcohol withdrawal is one of the contexts where benzodiazepines are appropriate rather than harmful.

Reference: NICE CG103; NICE CG100