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Alcohol withdrawal delirium — RCPSC EM MCQ

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ModeratePsychiatric emergenciesAlcohol withdrawal deliriumRCPSC EM

A 58-year-old man with alcohol use disorder is 30 hours from his last drink. He is tremulous, diaphoretic, hallucinating, and hypertensive; temperature is 38.1°C and CIWA-Ar is high. Glucose is normal and CT head is unremarkable. What is the most appropriate initial management?

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Correct answer: A — Benzodiazepine-based treatment plus thiamine and medical monitoring

Alcohol withdrawal delirium is treated with benzodiazepines, thiamine, fluids/electrolyte correction, and monitoring for complications. Antipsychotics may be adjunctive but are not sole therapy.

Reference: Canadian alcohol withdrawal management guidance; emergency medicine practice