مريض عمره ٥٢ سنة منوّم بعد عملية، آخر شرب للكحول قبل يومين. صار متعرق ونبضه ١٢٢ ويرى حشرات على الجدار ومشوش. ما الأرجح وما العلاج الأول؟

A 52-year-old post-op man last drank alcohol two days ago. He is sweating, HR 122, seeing insects on the wall and confused. What is most likely, and the first treatment?

1. Wernicke encephalopathy, IV glucose alone
2. Opioid withdrawal, treated with methadone
3. Acute alcohol intoxication, treated with naloxone
4. Alcohol withdrawal delirium, treated with a benzodiazepine

Answer: D) Alcohol withdrawal delirium, treated with a benzodiazepine. Delirium tremens appears 48–72 hours after the last drink with hallucinations, sweating and tachycardia; benzodiazepines are first-line, with thiamine before glucose.