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Severe alcohol withdrawal with delirium tremens — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsSevere alcohol withdrawal with delirium tremensSCE Acute Medicine

A 45-year-old man is admitted with agitation, tremor and visual hallucinations 36 hours after stopping heavy alcohol intake. BP is 176/104 mmHg, HR 132, temperature 37.9 C and he is disorientated. What is the most appropriate next step in management?

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Correct answer: D — Treat severe alcohol withdrawal with symptom-triggered benzodiazepines and parenteral thiamine

Autonomic hyperactivity, hallucinations and disorientation after cessation of heavy drinking indicate severe alcohol withdrawal or delirium tremens, requiring benzodiazepines and thiamine. Haloperidol may lower seizure threshold and does not treat the withdrawal physiology as sole therapy. Blood alcohol level does not need to be zero for withdrawal to occur. Thiamine should precede carbohydrate where possible to reduce Wernicke risk.

Reference: NICE CG100, NICE CG115, BNF