A 45-year-old chronic alcohol user is admitted for alcohol detoxification. On day 2, he develops visual hallucinations, confusion, and a seizure. His pulse is 120/min, BP 160/95, and he is diaphoretic. What is the IMMEDIATE treatment of choice?
- A Intravenous lorazepam ✓
- B Intravenous haloperidol
- C Oral diazepam loading
- D Phenytoin loading
Explanation
This patient has delirium tremens (severe alcohol withdrawal), presenting with hallucinations, confusion, autonomic instability, and seizure. The treatment of choice is benzodiazepines; intravenous lorazepam is preferred in the acute setting (seizure control, rapid onset, no active metabolites) over oral diazepam (which cannot be given IV for rapid effect in an actively seizing patient). Benzodiazepines act as positive allosteric modulators at GABA-A receptors, compensating for the upregulated excitatory (NMDA) receptors that emerge during alcohol withdrawal. Phenytoin is ineffective for alcohol withdrawal seizures as they are not a primary epileptic phenomenon.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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