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A 35-year-old female with a previous history of bipolar disorder and substance abuse presents to the emergency department with complaints of persistent nausea, recurrent vomiting, a fine tremor in her hands, and difficulty walking without stumbling. She also reports feeling lightheaded and dizzy. On examination, she appears anxious and has a noticeable tremor in both hands. Her vital signs are within normal limits, and an ECG shows flattened t waves. What is the most likely diagnosis?
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