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Alcohol withdrawal — MCCQE Part 1 MCQ

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HardSubstance UseAlcohol withdrawalMCCQE Part 1

A 51-year-old man with alcohol use disorder is 18 hours after his last drink and has tremor, diaphoresis, anxiety, BP 158/96 mmHg, pulse 118/min, and visual illusions. He has had a withdrawal seizure in the past. What is the most appropriate next step in management?

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Correct answer: D — Treat with symptom-triggered benzodiazepines and thiamine

Moderate to severe alcohol withdrawal with prior seizure risk should be treated with benzodiazepines, thiamine, fluids, and monitoring. Haloperidol may worsen seizure risk and does not treat withdrawal physiology when used alone. Disulfiram is not started during acute withdrawal. Thiamine should precede or accompany glucose to reduce Wernicke risk.

Reference: Canadian alcohol use disorder guidance; CAMH withdrawal resources