A 48-year-old alcoholic presents with agitation, tachycardia, hypertension, and autonomic hyperactivity; delirium tremens is suspected. What is the most appropriate initial management step?

• A. Start antihypertensive medication
• B. Begin a cardiac work-up for angina
• C. Admit to hospital for alcohol withdrawal
• D. Consult social services for disposition

Answer: (C)

Delirium tremens signals a medical emergency in alcohol withdrawal, so the priority is to manage the withdrawal in a monitored, inpatient setting. Admitting the patient allows immediate, continuous observation and initiation of a withdrawal protocol to prevent progression to seizures, arrhythmias, and severe electrolyte disturbances. In this setting, treatment focuses on controlled sedation with benzodiazepines, thiamine supplementation before glucose, IV fluids, electrolyte repletion, and nutrition, with careful monitoring and gradual tapering as symptoms improve. While addressing blood pressure is important, it is not the sole or immediate step and does not substitute for safe withdrawal management. A cardiac work-up or social services can be considered after stabilization if there are specific indications, but they do not take priority over inpatient withdrawal management in this scenario.