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Urinalysis
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0/16
Lorazepam
100%
16/16
Morphine
Antibiotics
Chest radiograph
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A patient with seizures in the setting of a history of high alcohol intake with abrupt cessation is most likely suffering from acute alcohol withdrawal and should be treated with benzodiazepines (BZDs). Alcohol withdrawal presents with many symptoms depending on the time from last consumption. At 12-24 hours after last consumption, it can present with tremors along with symptoms of anxiety, insomnia, and vital sign changes such as tachycardia and hypertension. One to two days later, it can also present with seizures and lead to complications such as psychotic symptoms and confusion. After two days, patients are at risk for potentially fatal delirium tremens, consisting of tremors, hallucinations, anxiety, and disorientation. Bayard et al. discuss alcohol withdrawal and its treatment. They state that BZDs (specifically longer-acting forms such as lorazepam or diazepam) are the mainstay of treatment to both treat and prevent future alcohol withdrawal. They note that repletion of other substances, such as fluids, thiamine, folate, and glucose, is also necessary to prevent long-term complications. Lastly, patients with hallucinations may also benefit from antipsychotics such as haloperidol. Holbrook et al. present a meta-analysis for treatment of alcohol withdrawal with BZDs. They report BZDs to be significantly superior to placebo for treatment of alcohol withdrawal (odds ratio = 3.28). They also note that there was no significant difference between benzodiazepines and alternative drugs in terms of adverse events and therefore should remain the mainstay for alcohol withdrawal treatment. Incorrect Answers: Answers 1 and 5: It is too early for this patient to manifest with a urinary tract infection or pneumonia. These typically occur 2-5 days after surgery. Additionally, this patient did not complain of any respiratory or urinary symptoms. Answer 3: Controlling the patient's pain is necessary and important, but this patient requires urgent intervention with a benzodiazepine. Answer 4: This patient has no current infectious etiology and should not receive antibiotics.
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