A man with alcohol dependence is admitted with tremor, sweating and agitation 36 hours after his last drink. Which approach is correct?
Answer and explanation
Correct answer: D. A benzodiazepine to control withdrawal, and thiamine given before glucose
- Step 1: Autonomic hyperactivity after stopping alcohol indicates withdrawal. Step 2. Benzodiazepines prevent seizures and delirium tremens, and thiamine protects against Wernicke encephalopathy. Answer: a benzodiazepine and thiamine first. Why not the others: antipsychotics lower the seizure threshold, glucose first can precipitate Wernicke, and withdrawal can be fatal.
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