Example case 14 of 40
A history that changes treatment
Recognise severe alcohol withdrawal
Ms Fraser, 58, becomes confused and tremulous after admission with pneumonia.
Click or tap each illustration to enlarge it. The commentary and text transcript follow below.
Read the text transcript
Page 1
Panel 1
Ms Fraser, 58, becomes confused and tremulous after admission with pneumonia.
Nurse Wilson: She is sweating and frightened. I need urgent help.
Panel 2
The doctor assesses immediate illness severity and possible causes.
Doctor Mehta: I will examine her now and check her blood glucose.
Panel 3
Her partner adds information about alcohol use.
Partner: She drinks every day. Her last drink was two days ago.
Panel 4
The assessment supports severe alcohol withdrawal with delirium.
Doctor Mehta: Withdrawal needs treatment alongside her other illness.
Panel 5
A benzodiazepine is prescribed under the withdrawal protocol, with close monitoring.
Doctor Mehta: We will review the medicines against her symptoms.
Panel 6
The team gives thiamine and assesses nutrition and fluids.
Nurse Wilson: We will keep checking what support she needs.
Panel 7
Overnight, continuing agitation prompts another medical review.
Nurse Wilson: She is still distressed despite treatment. Please reassess her.
Panel 8
Next day she is calmer, but attention still wanders.
Ms Fraser: I keep forgetting what you have just said.
Panel 9
Treatment, monitoring and plans for continuing care are reviewed.
Doctor Mehta: We will reassess you regularly and explain each step.
Commentary
Delirium associated with severe alcohol withdrawal requires urgent assessment, protocol-based treatment and close monitoring. Assess other causes and thiamine needs.
An anonymised composite case that does not describe one identifiable person and is not research evidence.