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Delirium Tremens — RACP Adult Medicine MCQ

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HardNeurologyDelirium TremensRACP Adult Medicine

A 60-year-old admitted with pancreatitis develops alcohol-withdrawal delirium, marked autonomic hyperactivity and a generalised seizure. Hypoglycaemia, hypoxia, head injury and major electrolyte disturbance have been excluded. Which management bundle is most appropriate?

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Correct answer: C — Use titrated benzodiazepine loading, give parenteral thiamine and manage the patient in a high-acuity monitored setting

Explanation lettering: E = shown as A · A = shown as D · D = shown as E

C is correct. Alcohol-withdrawal delirium with a seizure is a medical emergency requiring adequately titrated benzodiazepine treatment, parenteral thiamine and high-dependency or intensive monitoring when severe; other causes of delirium and seizure must be sought in parallel. D may occasionally supplement treatment for dangerous agitation but does not treat the withdrawal physiology or prevent seizures. E is ineffective for alcohol-withdrawal seizures once benzodiazepine treatment is available. A provides insufficient monitoring and unreliable initial thiamine absorption. B leaves a high-mortality syndrome untreated. Thiamine should precede carbohydrate when practicable, but urgently needed glucose for hypoglycaemia must never be dangerously delayed.

Reference: NSW Health: Management of withdrawal from alcohol and other drugs: https://www.health.nsw.gov.au/aod/professionals/Publications/managing-withdrawal.pdf