A 45-year-old man with chronic alcohol use disorder is admitted for elective surgery. On post-operative day two he develops tremors, diaphoresis, tachycardia, and visual hallucinations of insects crawling on the walls. He is agitated and disoriented. His BP is 160/100 mmHg. What is the most appropriate immediate pharmacological treatment?

• A Haloperidol to control agitation and hallucinations
• B Lorazepam with thiamine supplementation ✓
• C Oral clonidine to manage sympathetic hyperactivity
• D Propranolol to control tachycardia and hypertension

Explanation

This is alcohol withdrawal delirium (delirium tremens), typically appearing 48–72 hours after the last drink. Benzodiazepines, particularly long-acting ones such as diazepam or lorazepam (preferred when hepatic function is impaired), are the mainstay of treatment and prevent progression to seizures and death by cross-tolerance at GABA-A receptors. Thiamine must be given before or with any glucose to prevent precipitating or worsening Wernicke's encephalopathy. Antipsychotics lower the seizure threshold and are not first-line.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.