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Substance Use and Toxicology — Withdrawal syndromes

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Case 1 of 3Substance Use and ToxicologyWithdrawal syndromes (e.g., alcohol withdrawal, benzodiazepine withdrawal)

A 58-year-old man is admitted to the medical ward for cellulitis of the left leg and started on IV cefazolin. On hospital day 3 he becomes agitated, disoriented to place and time, diaphoretic and tremulous, and says he sees insects crawling on the bed sheets. His wife reports that he drinks about 12 beers a day and had his last drink 3 days ago. He takes no regular medications and has no known allergies. On examination he has a gross tremor of both hands and no focal neurological deficit, and the cellulitis is improving. His CIWA-Ar score is 24. Investigations show: glucose 5.4 mmol/L (3.9-7.8), potassium 3.2 mmol/L (3.5-5.0), magnesium 0.58 mmol/L (0.70-1.10), AST 38 U/L (10-40), ALT 33 U/L (10-40), platelets 245 x 10^9/L (150-400) and INR 1.0 (0.9-1.2). CT of the head is unremarkable.

Heart rate128/min
Respiratory rate22/min
Temperature38.2 °C
O2 saturation96%, room air
Blood pressure168/98 mm Hg

Question 1 of 9

Which of the following are the most appropriate initial medications?

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