A 37-Year-Old Man with a History of Depression, Alcohol, and Polysubstance

A 37-year-old man with a history of depression, alcohol, and polysubstance use comes to the emergency department saying, "I feel awful; I need help."  The patient says he was feeling fine until last night, when he developed abdominal cramps that were initially mild but gradually worsened in intensity.  Since this morning, he has had 4 loose stools with no blood or mucus.  The patient has also had persistent nausea but no vomiting.  He has had no fever.  His medications include paroxetine, clonazepam, and diphenhydramine.  Temperature is 36.6 C (97.8 F) , blood pressure is 144/98 mm Hg, pulse is 88/min, and respirations are 16/min.  Physical examination shows a diaphoretic, thin man in considerable distress.  His pupils are dilated.  This patient's clinical presentation is most consistent with withdrawal from which of the following drugs?

A) Alcohol
B) Amphetamine
C) Clonazepam
D) Cocaine
E) Diphenhydramine
F) Heroin
G) Paroxetine

Correct Answer:

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