A 70-year-old man is brought to the emergency department by his nephew due to redness and pain in his right leg. The patient lives alone and has no family except for the nephew, who occasionally checks on him. Other than a history of gastrointestinal bleeding, little is known about the patient's medical history. In the emergency department he is mildly febrile, but vital signs are otherwise normal. On physical examination, there is cellulitis of his lower right extremity and mildly tender hepatomegaly. Laboratory examination is normal except for a white blood cell count of 12,400/mm3, aspartate aminotransferase of 332 U/L, and alanine aminotransferase of 158 U/L. Chest x-ray and urinalysis are normal. The patient is admitted to the hospital and intravenous antibiotics are started. At the time of admission he appears calm and agrees to hospitalization. That night, the patient becomes irritable and restless. He is unable to sleep and becomes increasingly tremulous and diaphoretic, as well as argumentative with the nurse, whom he slaps on the hand as she tries to help him. Temperature is 37.2 C (99 F) , blood pressure is 160/90 mm Hg, pulse is 108/min, respirations are 18/min, and pulse oximetry is 93% on room air. The patient appears cognitively intact. Which of the following is the most appropriate pharmacotherapy for this patient?
A) Carbamazepine
B) Chlordiazepoxide
C) Haloperidol
D) Lorazepam
E) Propranolol
Correct Answer:
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