A 40 year old male with history of alcohol abuse for 20 years is brought to the hospital emergency with complaints of fearfulness, talking to self, aggressive behavior, tremulousness and saying that there insects crawling under his skin. Physical examination shows tachycardia, palpitations, sweating, and high grade fever. He is unable to recognize few of his family members. There is history of drinking alcohol two days prior to the onset of the present complaints. He is most likely suffering from?

Ans. is 'a' i.e., Delirium tremens * This patient hasA. H/O alcohol abuseB. Abstinence from alcohol drinking since two daysC. Tactile hallucination (insects crawling under the skin)D. Disorientation (not able to recognize family members, talking to self)E. Autonomic disturbances: - Tachycardia, sweating, tremors, fever, Anxiety (fearfulness and tremulousness)* All suggest the diagnosis of delirium tremensDelirium tremens* Delirium tremens is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant alcohol abstinence.* It has all the features of delirium : -1. Clouding of consciousness, Confusion or disorientation.2. Poor attention span and distractibility.3. Visual (and also auditory) hallucinations, illusions. Tactile hallucination of insects crawling under the skin (fornication).4. Marked autonomic disturbances: - Tachycardia, sweating, tremors, fever, hypertension, Anxiety and pupillary dilatation.5. Psychomotor agitation, ataxia, Insomnia with disturbed sleep wake cycle.* Benzodiazepines are the drugs of choice for delirium tremens. Chlordiazepoxide is the agent of choice with diazepam as an alternative.