Which feature best differentiates alcohol withdrawal delirium (delirium tremens) from alcohol hallucinosis?

Which feature best differentiates alcohol withdrawal delirium (delirium tremens) from alcohol hallucinosis?

• A. Onset relative to last drink
• B. Unstable vital signs such as hypertension and tachycardia
• C. Presence of visual hallucinations
• D. Normal pupillary responses

Answer: (B)

Delirium tremens is the severe alcohol withdrawal state that features delirium with autonomic hyperactivity. The strongest clue that sets it apart from alcohol hallucinosis is unstable vital signs, such as tachycardia, hypertension, and fever, reflecting a heightened physiological storm. In delirium tremens, this autonomic instability accompanies confused and fluctuating consciousness, agitation, and disorientation. By contrast, alcohol hallucinosis involves hallucinations—often auditory—while the patient’s sensorium remains clear and vitals remain relatively stable, without the marked autonomic signs. Timing after the last drink can overlap between these conditions, and hallucinations can occur in both, but the presence of significant autonomic instability is the key differentiator. Pupillary responses are not consistently helpful as differentiators.

Delirium tremens is the severe alcohol withdrawal state that features delirium with autonomic hyperactivity. The strongest clue that sets it apart from alcohol hallucinosis is unstable vital signs, such as tachycardia, hypertension, and fever, reflecting a heightened physiological storm. In delirium tremens, this autonomic instability accompanies confused and fluctuating consciousness, agitation, and disorientation. By contrast, alcohol hallucinosis involves hallucinations—often auditory—while the patient’s sensorium remains clear and vitals remain relatively stable, without the marked autonomic signs. Timing after the last drink can overlap between these conditions, and hallucinations can occur in both, but the presence of significant autonomic instability is the key differentiator. Pupillary responses are not consistently helpful as differentiators.