A 36-year-old man is admitted for alcohol withdrawal. The pa…
A 36-year-old man is admitted for alcohol withdrawal. The patient is initially treated with lorazepam injection as needed based on the Clinical Institute Withdrawal Assessment (CIWA) scale but develops respiratory depression, requiring transfer to the ICU and mechanical ventilation. To treat the symptoms of withdrawal, the patient was started on fentanyl infusion, midazolam infusion, and propofol infusion. Attempts to lower the sedation were met with extreme agitation and dyssynchrony with the ventilator. After 5 days, dexmedetomidine was introduced. A few hours later, the patient became bradycardic and hypotensive. A crystalloid bolus was started. The electrocardiogram (ECG) shows a second degree heart block. Laboratory analysis shows the following: Labs1.jpgAdditionally, his serum osmolality gap is elevated. Which is the responsible medication for the abnormal laboratory values?