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A 36-Year-Old Man Is Brought to the Emergency Department by His

question 477

Multiple Choice

A 36-year-old man is brought to the emergency department by his wife for treatment of severe restlessness. She says, "I told him he has to come in and get checked out. Last night, he didn't come home and was partying all night with friends. He finally admitted that he has been using drugs again and drinking for the past year without telling me." The patient is not forthcoming regarding the specific details of his drug and alcohol use. He feels depressed and suicidal with thoughts of hanging himself. He says, "I started using drugs again because it is the only thing that helps my depression." The patient's eating and sleeping have been erratic over the past month. In the emergency department, he feels "shaky" and has a headache and nausea but is cognitively intact. He has no other medical issues and does not use tobacco.
Temperature is 36.7 C (98 F) , blood pressure is 168/85 mm Hg, and pulse is 110/min. The patient is restless and diaphoretic. Cardiopulmonary examination is normal. The abdomen is soft and nontender. He has visible tremors of both hands and muscle twitches in all 4 extremities. At the end of the examination, he exhibits mild truncal myoclonic jerks.
Complete blood count and serum chemistries are unremarkable. Liver function tests are pending. Blood alcohol level is 70 mg/dL. Urine toxicology screen is positive for marijuana and heroin but negative for cocaine and amphetamines.
Intravenous fluids and a security watch are initiated.
Which of the following is the most appropriate next step in management of this patient?

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