MEDizzy - A 42-year-old man presents to the local crisis center

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Psychiatry-USMLE Set 1

A 42-year-old man presents to the local crisis center requesting alcohol detoxification. He has a 20-year history of heavy drinking, with the longest period of abstinence being four months. His last drink was two nights ago, and he now complains of discomfort and anxiety. Physical examination reveals coarse tremors, facial flushing, palmar erythema, and spider angiomas. His blood pressure is 145/95 mm Hg, his pulse is 115/min, and his temperature is 38.3°C (100.9°F). Thiamine is administered. Which of the following drugs is indicated for the treatment of this patient’s condition?

ExplanationThe correct answer is A. This patient is showing signs of alcohol withdrawal, manifested by tachycardia, fever, nausea, vomiting, tremors, and hypertension, and is at risk for delirium tremens. Delirium tremens is an extreme and life-threatening form of withdrawal characterized by perceptual disturbances and confusion. Intravenous benzodiazepines, such as chlordiazepoxide, are indicated in the treatment of both mild withdrawal and delirium tremens. Used early, they can prevent progression to withdrawal-induced seizures, psychosis, and coma. Chlordiazepoxide is a long-acting benzodiazepine that works via stimulation of GABA receptors. Other drugs in the same class include lorazepam, oxazepam, and diazepam, each of which could be used in this scenario. Answer B is incorrect. Disulfiram inhibits acetaldehyde dehydrogenase, which causes accumulation of acetaldehyde with ingestion of alcohol. This buildup of alcohol byproducts leads to extremely unpleasant adverse effects, including flushing, headache, diaphoresis, nausea, and vomiting. This drug is given to alcoholics to help them maintain sobriety. Answer C is incorrect. Haloperidol is a typical antipsychotic. It can be used in patients withdrawing from alcohol who suffer psychotic symptoms such as hallucinations. Answer D is incorrect. Methadone is a potent, long-acting opioid agonist used in the treatment of opioid addiction. This patient is an alcoholic and does not require a methadone taper.