Alcohol withdrawal seizures typically occur within what time window after the last drink, and which drug is first-line treatment to prevent them in high-risk patients?
- A 6–48 hours; long-acting benzodiazepines (e.g., chlordiazepoxide or diazepam) ✓
- B 6–24 hours; phenytoin
- C 48–72 hours; carbamazepine
- D 72–96 hours; clonidine
Explanation
Alcohol withdrawal follows a predictable timeline: tremors and autonomic instability within 6–12 hours, seizures (grand mal) within 6–48 hours (peak at 24 hours), and delirium tremens at 48–72+ hours. Long-acting benzodiazepines (diazepam, chlordiazepoxide) are first-line for preventing and treating alcohol withdrawal, including seizures, due to cross-tolerance at GABA-A receptors. They use symptom-triggered or fixed-schedule protocols (CIWA-Ar). Phenytoin is NOT effective for alcohol withdrawal seizures (GABA-mediated pathophysiology is distinct from epileptic seizures). Carbamazepine has evidence primarily in mild-moderate withdrawal in non-hospitalised patients.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.