In Complicated Alcohol Withdrawal, which statement is accurate?

• A. Alcoholic hallucinosis occurs 12-48 hours after last drink and typically has normal vital signs and clear sensorium.
• B. Withdrawal seizures occur 6-48 hours after last drink and involve normal vital signs.
• C. Delirium tremens occurs within 24 hours.
• D. Hallucinations are always visual only.

Answer: (A)

Recognizing distinct timing and mental-status patterns in alcohol withdrawal helps distinguish alcoholic hallucinosis from other syndromes. Alcoholic hallucinosis occurs after cessation of drinking, typically within 12–48 hours, and features persistent hallucinations while the patient remains oriented with normal vital signs. This combination—hallucinations with a clear sensorium and stable physiology—best fits the statement. In contrast, delirium tremens usually emerges later (roughly 48–72 hours or more) and brings confusion, fluctuating consciousness, and autonomic instability; hallucinations can occur but are not the defining feature and the patient’s cognition is impaired. Withdrawal seizures also occur in the same general time window (often within 12–48 hours) but involve actual convulsions, and the hallmark is not preserved orientation with stable vitals in between episodes. Hallucinations in withdrawal aren’t limited to vision; they can be auditory as well, though alcoholic hallucinosis tends to be auditory and occurs with a clear sensorium.