مريض في اليوم الرابع من انسحاب الكحول، مشوش جداً، يرى حشرات على الجدار، وحرارته ٣٨٫٧، ونبضه ١٣٢، ويتعرق بشدة. ما الحالة؟

On day 4 of alcohol withdrawal a client is very confused, sees insects on the wall, has a temperature of 38.7 °C, HR 132 and profuse sweating. What is this?

1. Bacterial food poisoning
2. A migraine attack with aura
3. Mild anxiety after stopping alcohol
4. Delirium tremens, an emergency

Answer: D) Delirium tremens, an emergency. Delirium tremens typically appears 48–96 hours after the last drink with confusion, hallucinations and autonomic instability, and can be fatal. It needs intensive monitoring, benzodiazepines, fluids and thiamine.