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Alcohol withdrawal syndrome — ABIM Board MCQ

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HardPsychiatry relevant to IMAlcohol withdrawal syndromeABIM Board

A 55-year-old man with decompensated cirrhosis develops moderate alcohol withdrawal with tremor, diaphoresis, and agitation. He is not delirious and can be closely monitored. Which benzodiazepine is preferred to reduce accumulation from impaired hepatic oxidation?

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Correct answer: A — Use symptom-triggered lorazepam with close clinical monitoring

The best answer is “Use symptom-triggered lorazepam with close clinical monitoring”. Lorazepam and oxazepam rely mainly on glucuronidation and are less affected by hepatic oxidative impairment than diazepam or chlordiazepoxide. Symptom-triggered dosing in an adequately monitored setting limits oversedation. Liver disease does not remove the need to treat withdrawal, provide thiamine, and monitor for progression.

Reference: ASAM Clinical Practice Guideline on Alcohol Withdrawal Management: https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/quality-science/the_asam_clinical_practice_guideline_on_alcohol-1.pdf