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Alcohol withdrawal delirium — SCE Acute Medicine MCQ

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EasyToxicology and OverdoseAlcohol withdrawal deliriumSCE Acute Medicine

A 52-year-old man is assessed on the acute medical unit. He is 48 hours after his last drink with tremor, sweating, agitation and visual hallucinations. He is tachycardic and hypertensive. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Give symptom-triggered benzodiazepine therapy

Give symptom-triggered benzodiazepine therapy is the best answer because acute alcohol withdrawal with autonomic features and hallucinations is treated with benzodiazepines and thiamine. Give activated charcoal within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Give parenteral thiamine before carbohydrate in high-risk dependent drinkers.

Reference: NICE CG100; BNF