A 44-year-old man is brought to the emergency department by paramedics after he was found stumbling and confused at home. ..

A 44-year-old man is brought to the emergency department by paramedics after he was found stumbling and confused at home.
On physical examination, the patient appears slightly sedated and admits to recent heavy drinking but says his last drink was 34 hours ago. He also says he vomited three times earlier that morning. He denies chest and abdominal pain. He has a 15-year history of heavy alcohol abuse and usually drinks six to seven beers a day.
CT scan of the head is negative for mass lesions or bleeding.
Relevant laboratory findings are as follows:
Aspartate aminotransferase: 57 U/L
Alanine aminotransferase: 18 U/L
Lactate dehydrogenase: 398 U/L

What is the most likely diagnosis?
Alcohol withdrawal.

What is the pathophysiology of this condition?
Alcohol is a central nervous system depressant that causes neuronal changes, including stimulation of the γ-aminobutyric acid (GABA)A receptor. Repeated consumption of alcohol desensitizes GABAA receptors, resulting in tolerance and physical dependence. When a person suddenly stops consuming alcohol, the nervous system is hyperaroused and synapses fire uncontrollably; the result is the symptoms seen in alcohol withdrawal. Increased serum norepinephrine and altered serotonin levels have also been implicated in both alcohol craving and tolerance.

What are the symptoms of this condition?

Minor symptoms (occurring 6–36 hours after the last drink) include: diaphoresis, GI upset, headache,
nausea and vomiting, palpitations, and tremulousness. Seizures can occur within 6–48 hours of the last drink. Visual (or less commonly, tactile or auditory) hallucinations can occur within 12–48 hours of the last drink, and delirium tremens may occur within 48–96 hours.

What is delirium tremens?
Delirium tremens is a collection of severe alcohol withdrawal symptoms that includes delirium, agitations, and autonomic instability such as tachycardia, hypertension, low-grade fever, and diaphoresis. Approximately 5% of patients with alcohol withdrawal symptoms develop delirium tremens.

What is the appropriate treatment for this condition?
Benzodiazepines, particularly lorazepam or diazepam, are the treatment of choice for all types of alcohol withdrawal symptoms.