QuestionSBA
QuestionChoice
Vitamin replacement is an important aspect of managing patients with chronic alcohol consumption however this will not treat his acute withdrawal symptoms.
10028498
b
Thiamine 100 mg PO OD
QuestionChoice
Though this patient describes nausea, the most appropriate management at this stage is to give a benzodiazepine to treat his acute withdrawal. Anti-emetics may be a part of his management plan but are not the most important aspect of it.
10028500
d
Ondansetron 4 mg PO TDS
QuestionChoice
Benzodiazepines such as chlordiazepoxide are the recommended first-line treatment of acute alcohol withdrawal. This is an acceptable starting dose, with a formal regime to be decided based on this patient's CIWA scoring.
10028497
a
Chlordiazepoxide 20mg PO 6-hourly
QuestionChoice
While this patient has a tremor, he is suffering acute alcohol withdrawal and propranolol is not appropriate for this.
10028501
e
Propranolol 50mg PO PRN
QuestionChoice
This may be given if the patient was very agitated and either a risk to himself and/or others with verbal de-escalation tactics failing, however there is no description of this behaviour in the stem.
10028499
c
Lorazepam 2 mg PO STAT
QuestionComment
when do you give thiamine/pabrinex vs chlordiaxopide ?
40471
QuestionComment
chlordiazepoxide is used to treat the acute alcohol withdrawal symptoms

you use thiamine to prevent thiamine deficiency in severe alcoholics or to treat Wernickes - so would need to have: 1) altered mental state 2) ophthalmoplegia 3) ataxic gait
40487
User
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Acute Fever
QuestionComment
Happy to be corrected but I interpreted this patient as having acute alcohol withdrawal symptoms (nausea, anxiety, tremor) so opted for chlordiazepoxide as this would manage the withdrawal symptoms. 

If the patient presented with symptoms of Wernicke's (ophthalmoplegia, ataxia, and confusion) think it would more appropriate to give pabrinex first? 
40516
User
subscriber
Kinin Dominatrix
User
subscriber
Neoplasia Nightshift
Concept
Chapter
2693
6074
Alcohol withdrawal
Topic
322
Medicine
18099
Case Presentation: A 43-year-old man attends A&E with nausea, worsening tremor and says he is feeling very anxious and 'on edge'. He is a frequent attender with similar presentations and decided two days he was going to stop drinking completely. He says it has been at least 36 hours since his last drink. **PH** Chronic alcohol abuse, Depression **DH** Omeprazole 30mg PO daily, Sertraline 50mg PO daily NKDA




 **On examination**


Appears anxious and sweaty, but orientated in time and place. Peripheries warm, CRT < 2s. Pulse regular.


Temperature 37.4°C, HR 112, RR 14, BP 115/78, O2 94% RA, AMTS 8/10


 **Investigations**


FBC, U+E, LFT, clotting profile - in-lab


Point of care glucose: 7 mmol/L (normal <6.1 mmol/L)


Question: Select the most appropriate management at this stage.
a