A 40-year-old man presents to casualty with history of regular and heavy use of alcohol for 10 years and morning drinking for one year. The last alcohol intake was three days back. There is no history of head injury or seizures. On examination, there is no icterus, sign of hepatic encephalopathy or focal neurological sign. The patient had coarse tremors, visual hallucinations and had disorientation to time. Which of the following is the best medicine to be prescribed for such a patient:March 2013 (e)
A 40-year-old man presents to casualty with history of regular and heavy use of alcohol for 10 years and morning drinking for one year. The last alcohol intake was three days back. There is no history of head injury or seizures. On examination, there is no icterus, sign of hepatic encephalopathy or focal neurological sign. The patient had coarse tremors, visual hallucinations and had disorientation to time. Which of the following is the best medicine to be prescribed for such a patient:March 2013 (e)
π‘ Explanation
**Core Concept**
Delirium tremens (DTs) is a severe and potentially life-threatening complication of alcohol withdrawal, characterized by altered mental status, tremors, and hallucinations. It occurs when the body is unable to adapt to the sudden absence of alcohol, leading to an imbalance of neurotransmitters such as GABA and glutamate.
**Why the Correct Answer is Right**
Benzodiazepines, specifically lorazepam, are the treatment of choice for delirium tremens. They work by enhancing the activity of GABA, a neurotransmitter that has a calming effect on the brain, thereby reducing the symptoms of DTs. Lorazepam is preferred over other benzodiazepines due to its long half-life, which allows for easier titration and less risk of withdrawal.
**Why Each Wrong Option is Incorrect**
**Option A:** Chlorpromazine is an antipsychotic medication that may be used to manage hallucinations, but it is not the first-line treatment for delirium tremens and may even exacerbate the condition.
**Option B:** Haloperidol is an antipsychotic medication that can be used to manage agitation and hallucinations, but it is not the treatment of choice for delirium tremens and may increase the risk of neuroleptic malignant syndrome.
**Option C:** Phenytoin is an antiepileptic medication that may be used to manage seizures, but it is not indicated for the treatment of delirium tremens.
**Clinical Pearl / High-Yield Fact**
The "rum fit" is a colloquial term for seizures that occur during alcohol withdrawal, often in the absence of a clear history of seizure disorder. Benzodiazepines, such as lorazepam, are effective in preventing and treating seizures during alcohol withdrawal.
**Correct Answer: C. Lorazepam**
β Correct Answer: A. Diazepam
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