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Delirium tremens during hospital admission — SCE Acute Medicine MCQ

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ModeratePsychiatryDelirium tremens during hospital admissionSCE Acute Medicine

A 51-year-old man with alcohol dependence is admitted after a fall. Forty-eight hours later he is tremulous, hallucinating and severely agitated; temperature is 38.1°C, pulse 134/min and blood pressure 176/98 mmHg. He has not received regular benzodiazepines. What is the most appropriate next step in management?

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Correct answer: C — Treat as delirium tremens with symptom-triggered benzodiazepines and parenteral thiamine

Delirium tremens presents 48–72 hours after alcohol cessation with autonomic hyperactivity, agitation and hallucinations, requiring benzodiazepines, thiamine and close monitoring. Antipsychotics may be adjunctive for severe hallucinations but do not treat the withdrawal physiology. Untreated delirium tremens carries significant mortality.

Reference: NICE CG100 alcohol-use disorders; NICE CG115 alcohol dependence