Alcohol withdrawal — MCCQE Part 1 MCQ

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ModerateSubstance UseAlcohol withdrawalMCCQE Part 1

A 30-year-old man stopped heavy daily alcohol use two days ago. He now has marked tremor, diaphoresis, tachycardia and visual hallucinations, and is judged at high risk for severe withdrawal complications. What is the most appropriate management?

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Correct answer: C — Inpatient benzodiazepine-based withdrawal management

He has active, severe alcohol withdrawal and is at high risk for seizures or delirium. Current Canadian guidance recommends short-term benzodiazepine treatment for high-risk withdrawal, ideally in a monitored inpatient withdrawal-management facility or hospital. Care also includes frequent reassessment, fluids and electrolytes as indicated, and thiamine to prevent Wernicke encephalopathy; treatment should then link directly to ongoing alcohol-use-disorder care. Naltrexone is a relapse-prevention medication, not acute withdrawal treatment. Outpatient gabapentin is reserved for selected low-risk patients. Antipsychotics do not prevent withdrawal seizures and should never replace adequate sedative treatment.

Reference: CRISM/BCCSU Canadian Alcohol Use Disorder Guideline, withdrawal recommendations 5 to 8: https://crism.ca/alcohol-use-disorder/