A 45-year-old client is brought to the emergency department 8 hours after abruptly discontinuing a substance. The client is restless and irritable, has coarse hand tremors, blood pressure 160/92 mm Hg, heart rate 118/min, diaphoresis, and mild confusion. Withdrawal from which substance best explains these assessment findings?
Heroin
Cannabis
Cocaine
Alcohol
Withdrawal from central nervous system depressants such as alcohol produces autonomic hyperactivity (tachycardia, hypertension, diaphoresis), coarse tremor, agitation, and altered sensorium within 6-24 hours of the last intake. These features match the client's presentation. Opioid (heroin) withdrawal causes rhinorrhea, lacrimation, abdominal cramping, and piloerection rather than severe tremors and hypertension. Stimulant (cocaine) intoxication-not withdrawal-causes agitation and tachycardia; cocaine withdrawal is characterized mainly by fatigue and depression. Cannabis withdrawal produces irritability and sleep disturbance but not marked tremor or autonomic instability. Therefore, alcohol withdrawal is the most likely etiology.
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