06-27-2007, 08:54 AM
A 64-year-old chronic alcoholic is admitted to the hospital for the evaluation of an occult gastrointestinal
bleed and anemia. He has been a heavy drinker for years and reports numerous admissions to the
hospital because of injuries, seizures, and other medical problems related to alcohol abuse. He gives a
history of "the shakes" when he does not drink and a history of having been in delirium tremens a few
times. On the CAGE questionnaire he scores a 4 out of 4. The patient is also a heavy smoker and has
been diagnosed with COPD. The team is aware that this patient may need to be detoxified because he
might end up developing withdrawal symptoms while in the hospital. His physical examination is
significant for an enlarged liver and spider angiomata, as well as polyneuropathy secondary to alcohol
abuse. His liver function tests show values 4 times greater than normal. Given this patient's medical
condition, the most appropriate first-line detoxification agent is
A. carbamazepine
B. chlordiazepoxide
C. disulfiram
D. lorazepam
E. phenobarbital
bleed and anemia. He has been a heavy drinker for years and reports numerous admissions to the
hospital because of injuries, seizures, and other medical problems related to alcohol abuse. He gives a
history of "the shakes" when he does not drink and a history of having been in delirium tremens a few
times. On the CAGE questionnaire he scores a 4 out of 4. The patient is also a heavy smoker and has
been diagnosed with COPD. The team is aware that this patient may need to be detoxified because he
might end up developing withdrawal symptoms while in the hospital. His physical examination is
significant for an enlarged liver and spider angiomata, as well as polyneuropathy secondary to alcohol
abuse. His liver function tests show values 4 times greater than normal. Given this patient's medical
condition, the most appropriate first-line detoxification agent is
A. carbamazepine
B. chlordiazepoxide
C. disulfiram
D. lorazepam
E. phenobarbital