A client with heavy recent alcohol use develops confusion and visual hallucinations on day 2 of hospitalization. What is the most likely diagnosis?

• A. Alcohol Withdrawal Delirium
• B. Wernicke's Encephalopathy
• C. Korsakoff's Psychosis
• D. Alcohol Withdrawal

Answer: (A)

Heavy alcohol use followed by confusion and visual hallucinations within 48–72 hours after last drink is classic for delirium tremens, the severe form of alcohol withdrawal. This state typically emerges about day 2 of hospitalization and features marked confusion, agitation, and hallucinations, often with autonomic signs. Wernicke's encephalopathy results from thiamine deficiency and presents with oculomotor abnormalities, ataxia, and confusion, not the acute delirious state seen here. Korsakoff's psychosis is a later, chronic condition with profound memory problems and confabulation, not an acute delirium. General alcohol withdrawal can include tremors and anxiety but usually lacks the pronounced confusion and visual hallucinations of delirium tremens.