A 45-year-old chronic heavy alcohol user is admitted following a road traffic accident. On admission he is oriented and his blood alcohol level is 220 mg/dL. Fourteen hours later he develops tremors, agitation, diaphoresis, and a generalized tonic-clonic seizure. His blood pressure is 170/100 mmHg and heart rate is 112/min. What is the mainstay pharmacological treatment for this condition?
- A Haloperidol
- B Lorazepam (benzodiazepine) ✓
- C Phenytoin
- D Methadone
Explanation
Alcohol withdrawal syndrome results from CNS hyperexcitability following abrupt cessation in physically dependent individuals, with severe forms including withdrawal seizures (typically 12–48 hours after last drink) and delirium tremens (24–72 hours). Benzodiazepines are the cornerstone of treatment as they are cross-tolerant with alcohol at GABA-A receptors, controlling autonomic hyperactivity and preventing seizure progression to delirium tremens. Phenytoin is ineffective for alcohol withdrawal seizures. The CIWA-Ar scale guides symptom-triggered dosing. IV thiamine should be given before glucose to prevent Wernicke's encephalopathy.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.