A chronic alcoholic patient develops symptoms 48–72 hours after stopping alcohol. He presents with confusion, agitation, tremors, and elevated blood pressure. Which of the following is a characteristic feature of delirium tremens?

1. A

   Hypertension with altered consciousness

2. B

   Bradycardia with clear sensorium

3. C

   Hypotension with drowsiness

4. D

   Euphoria with normal vitals

Appeared in: NORCET 10 Prelims-2026

Explanation

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• Delirium tremens (DTs) is the most severe manifestation of alcohol withdrawal.
• A core feature of DTs is profound autonomic hyperactivity, which leads to elevated blood pressure (hypertension), rapid heart rate (tachycardia), fever, and sweating.
• Simultaneously, patients experience a global confusional state, or delirium, which is a form of altered consciousness.
• Therefore, the combination of hypertension and altered consciousness is a hallmark presentation of this medical emergency.

Why Other Options Were Wrong

• Option B: Patients with DTs experience tachycardia (a rapid heart rate) due to autonomic hyperactivity, not bradycardia (a slow heart rate). Their sensorium is, by definition, altered and confused, not clear.
• Option C: The sympathetic surge in DTs causes hypertension (high blood pressure), not hypotension (low blood pressure). While consciousness fluctuates, the patient is typically agitated and hyper-alert rather than just drowsy.
• Option D: DTs is a state of extreme distress, fear, and agitation, not euphoria (a feeling of intense happiness). The vital signs are severely abnormal, not normal.

Related Visual

• Visual 1: Flowchart: Timeline of Alcohol Withdrawal Symptoms. This would show the progression from minor symptoms (tremors, anxiety) to major symptoms like seizures and delirium tremens over 1-4 days.
• Visual 2: Table: Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) Scale. This visual would help students understand how withdrawal severity is objectively scored based on symptoms like tremor, sweating, anxiety, and orientation.
• Visual 3: Infographic: The Autonomic Storm of DTs. This could visually depict the effects of sympathetic overdrive on different body systems (heart, blood vessels, brain, skin).

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Clinical features of Delirium Tremens (Alcohol Withdrawal) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Recognizing the signs of DTs is a critical nursing skill. The combination of altered mental status and autonomic instability is a red flag for this life-threatening emergency.
• Nurses are responsible for frequent monitoring of vital signs and neurological status using tools like the CIWA-Ar scale to guide treatment, which typically involves administering benzodiazepines (e.g., diazepam, lorazepam).
• A key nursing intervention is to provide a quiet, low-stimulus environment to reduce agitation and prevent patient harm.

How to Approach the Question

• First, analyze the clinical scenario presented in the question stem. Identify the key patient details: a chronic alcoholic who has recently stopped drinking.
• Note the specific signs and symptoms: confusion, agitation, tremors, and elevated blood pressure, occurring within the 48-72 hour timeframe.
• Synthesize these findings to form a diagnosis. This clinical picture is a classic presentation of Delirium Tremens (DTs).
• Next, evaluate each option to see which one accurately describes a characteristic feature of the diagnosed condition (DTs).
• Option A links hypertension (autonomic hyperactivity) and altered consciousness (delirium), which are the two core components of DTs.
• Eliminate the other options by comparing them to the known pathophysiology of DTs. Recognize that bradycardia, hypotension, and normal vitals are inconsistent with the sympathetic storm that defines this condition.

Concept Tested & Keywords

• Concept Tested: Clinical features of Delirium Tremens (Alcohol Withdrawal)
• Stem keywords: chronic alcoholic, 48–72 hours after stopping alcohol, confusion, agitation, tremors, elevated blood pressure, delirium tremens
• Lead-in keywords: characteristic feature
• Clinical cues: The timeframe of 48-72 hours after cessation of alcohol is classic for the onset of Delirium Tremens.
• Clinical cues: The combination of neurological symptoms (confusion, agitation) and autonomic signs (elevated BP) points directly to DTs.

Question ID

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