A 40 year old chronic alcoholic is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. He has missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgement and insight. What is he is most likely to be suffering from?

This man in the question is an alcoholic who has not taken alcohol since 2 days. He is suffering from features of delirium tremens. Classic delirium tremens typically appears after 3-4 days of abstinence from alcohol (range: 24 hours to 7 days). Patients presents with tremor, agitation, excess motor activity (affecting the face, tongue, and extremities) and purposeless activity such as picking at the bedclothes and hallucinations. On examination, they are not oriented to time and place, febrile, tachycardic, have dilated pupils and hyperhidrosis. Ref: CURRENT Diagnosis and Treatment Emergency Medicine, 7th Edition, Chapter 37