## Alcohol Withdrawal Syndrome — Clinical Features ### Timeline and Manifestations **Key Point:** Alcohol withdrawal progresses through predictable stages with distinct clinical features and timing. | Feature | Timing | Characteristics | |---------|--------|------------------| | Tremor (Minor withdrawal) | 6–24 hours | Fine tremor of hands, autonomic hyperactivity | | Hallucinosis | 12–48 hours | **Auditory > visual**, patient has **clear sensorium** (knows hallucinations aren't real) | | Withdrawal seizures | 6–48 hours (peak 12–24 hrs) | Generalized tonic-clonic, brief duration | | Delirium tremens (DTs) | 48–96 hours | Visual/tactile hallucinations, **disorientation, confusion, autonomic storm** | ### Why Option 1 Is Incorrect **High-Yield:** Hallucinations in alcohol hallucinosis occur in a **clear sensorium** — the patient is oriented and aware the hallucinations are not real. This distinguishes hallucinosis from **delirium tremens**, where hallucinations are accompanied by profound disorientation and confusion. The statement says hallucinations are "predominantly visual" — this is **incorrect**. In alcohol hallucinosis, hallucinations are **predominantly auditory** (often accusatory or threatening voices). Visual hallucinations are more characteristic of delirium tremens. ### Autonomic Hyperactivity **Clinical Pearl:** Tachycardia, hypertension, diaphoresis, anxiety, and agitation reflect sympathetic overdrive and are present across all stages of withdrawal, beginning within hours of last drink. ### Seizure Characteristics **Key Point:** Withdrawal seizures are brief, generalized tonic-clonic convulsions. Status epilepticus is rare. Seizures typically occur 6–48 hours after last drink, with peak incidence at 12–24 hours. [cite:Harrison 21e Ch 474]
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