Snapshot A 46-year-old male underwent an emergency operation for a lung laceration from an altercation. Twenty-four hours later, he developed anxiety, tremors, and insomnia. The patient is started on a benzodiazepine taper, thiamine, multivitamin, IV fluids, and dextrose. Introduction Occurs when a chronic alcohol drinker is suddenly restricted from drinking can be initiated by an acute hospital stay assessed with Clinical Institute Withdrawal Assessment for Alcohol (CIWA) Presentation Symptoms early (12-24 hours) autonomic hyperactivity symptoms tremor, tachycardia, hypertension, anxiety, and insomnia mid (24-48 hours) seizures late (48-72 hours) delirium tremens psychotic symptoms and confusion Treatment Pharmacologic thiamine (administer prior to glucose to prevent worsening of or precipitation of Wernicke encephalopathy) glucose folate sedative-hypnotics with taper e.g., clonidine or propranolol lorazepam if seizures present phenobarbital long half life highly effective interacts with medications that induce or inhibit CYP system haloperidol if psychosis present Complications Minor Withdrawal Alcoholic Hallucinosis Withdrawal Seizure Delirium Tremens Time Since Last Drink 6 hours 12 - 24 hours 48 hours 48 - 96 hours Symptoms Trembling Irritability Anxiety Headache Tachycardia Insomnia Visual, auditory, and in some cases tactile hallucinations Tonic-clonic seizures Autonomic instability Disorientation Hallucinations Agitation Management Thiamine Folate Multivitamin Dextrose IV Flulids Begin benzodiazepine taper to avoid seizures Benzodiazepine taper Head CT Suspect in patient with unknown history followed by DT symptoms 2 days later Benzodiazepine taper prognosis Delirium tremens is associated with a high mortality
QUESTIONS 1 of 1 1 Previous Next (M2.PY.16.4682) A 45-year-old man has a history of smoking 1 pack per day and drinking a six-pack of beer daily over the last ten years. He is admitted to the medical floor after undergoing a cholecystectomy. One day after the surgery, the patient states that he feels anxious and that his hands are shaking. While being checked for a clean surgical site, the patient starts shaking vigorously and loses consciousness. The patient groans and falls to the floor. His arms and legs begin to jerk rapidly and rhythmically. This episode lasts for almost five minutes, and the patient's airway, breathing, and circulation are stabilized per seizure protocol. What is the best next step for this patient? QID: 107303 Type & Select Correct Answer 1 Urinalysis 0% (0/16) 2 Lorazepam 100% (16/16) 3 Morphine 0% (0/16) 4 Antibiotics 0% (0/16) 5 Chest radiograph 0% (0/16) M 7 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic