<prompt> A chronic alcoholic patient is brought to the emergency department by his wife. The person has not consumed alcohol for the past two days due to religious reasons. The person complained of nausea, vomiting and dizziness. On the second day. he developed seizures, that progressed to generalized tonic clonic seizures GTCS. Which of the following would be best medication to manage the seizure of the patient?Sodium valproatePhenytoinDiazepamCarbamazepine  <response>: Ans. c. Diazepam Ref: Niraj Ahuja 6e p39-40; Kaplan and Sadocks 9e p1278, 1284-1285The seizures in this patient, is due to alcohol withdrawal. Diazepam would be best medication to manage the seizure of the patient.Symptoms of Alcohol withdrawal:Hang over MCQHallucinationsQ usually auditory and illusionsQInsomniaQSeizures Alcoholic seizuresRum fitsQDelirium tremens;Occurs within 5 daysQ of complete or significant abstinenceQ from from heavy alcohol drinking Recovery occurs within 7 daysCharacteristic features are clouding of consciousnessQ, disorientationQ, hallucinations mostly visual and auditoryQ, illusionQ, autonomic disturbancesQ, agitationQ and insomniaQ.Long acting benzodiazepines such as chlordiazepoxide and diazepam or short acting such as Iorazepam can he used to treat mild-moderate uncomplicated alcohol withdrawal.Chlordiazepoxide is preferred over diazepam for treatment of alcohol withdrawal syndrome.Management ofAlcohol IntoxicationAlcohol WithdrawalDelirium TremensDrugs used are: Lorazepam can worsen the vitals due to CNS depression Haloperidol can lower seizure threshold Other drugs which may be used: Ziprasidone Olanzapine All patients should be given multiple oral vitamin B1 including 50-100 mg of thiamine daily for a week. Replace alcohol CNS depressant with any other CNS depressant. Benzodiazepines are commonly used. Chlordiazepoxide is drug of choice because of its long half- life. High dose benzodiazepines or antipsychotics arerecommended. Anticonvulsants are not given to control seizures seen in delirium tremens. Withdrawal SyndromesSubstanceFeaturesOpioid YawningQ, Insomnia. Dysphoric mood Water loss from different orificesQ LacrimationQ, sweatingQ, diarrheaQ, vomiting, rhinorrheaQ Increased vitalsQ BP, Pulse, RR, TemperatureQ Pupilary dilation, piloerectionQAlcoholHls delirium Hang over MCQ HallucinationsQ usually auditory and illusionsQ InsomniaQ Seizures Alcoholic seizuresRum fitsQ Delirium tremens:- Occurs within 5 daysQ of complete or significant abstinenceQ from from heavy alcohol drinking- Recovery occurs within 7 days- Characteristic features are clouding of consciousnessQ, disorientationQ, hallucinations mostly visual and auditoryQ, illusionQ, autonomic disturbancesQ, agitationQ and insomniaQ.Cocaine Increased or decreased- Sleep hypersomniaQ or insomnia- Psychomotor activity Vivid unpleasant dreamsQ Increased apetite and fatigueRemember:Drug of choice in withdrawal syndromeOpium Methadone 1st choice Clonidine 2nd choiceAlcohol Chlordiazepoxide 1st choice Diazepam 2nd choiceTreatment of Alcohol DependenceAversion therapy: ApomorphineQ, sub-threshold electric shockPsychotherapyGroup therapyDeterrent agents: Alcohol sensitizing drugsQDisulfiramQCitrated calcium carbimide CCCMetronidazoleQ, NitrafezoleQMethyltetrazolethiolSulfonylureas specially ChlorpropamideQCephalosporins cefoperazoneQ, moxalactamQ, cefamandoleQAnticraving agents: FANFluoxetineQAcamprosateQNaltrexoneQ 