AccessMedicine's Case of the Week: Alcohol Withdrawal

From: Resident Readiness Internal Medicine
AccessMedicine's Case of the Week: Alcohol Withdrawal


A 48-year-old man is admitted to a hospital because of pneumonia. Two days after the hospitalization, the patient becomes agitated and restless with tachycardia and hypertension. On physical examination, the patient is noted to be alert, but anxious, tremulous, and disoriented to place and time. And these findings differ from those on examination at admission. His alcohol history is significant (eg, drinking 3 or more vodkas a day for years; most recent alcohol intake occurred 2 days before coming to the hospital), but no history of liver diseases or alcohol withdrawal is evident. Subsequent physical examinations reveal no specific changes from the admission assessment except disorientation and anxiety. His respiratory status appears stable, and repeated CXR does not show any progression compared with the admission assessment. Routine laboratory workups including CBC, CMP, EKG, and blood glucose are stable. Since he has a history of alcohol dependence, alcohol withdrawal is considered.


  1. What is the next step to determine the treatment?
  2. Once you start medications, how do you adjust the dose of them?
  3. And before deciding how to give them, what should you consider first?

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