A 32-year-old female has a single episode of tonic-clonic seizure activity. She quit drinking yesterday. Which should you suspect?

• A. Alcohol withdrawal.
• B. Hypoglycemia.
• C. Alcohol intoxication.
• D. Diabetic ketoacidosis.

Answer: (A)

The key idea is that a seizure occurring after stopping alcohol in someone who has been drinking heavily points to alcohol withdrawal as the likely cause. When a person with chronic, heavy alcohol use abruptly ceases drinking, the brain’s reduced GABA activity and increased excitability from glutamate can trigger seizures as part of withdrawal. These withdrawal seizures commonly surface within about a day of the last drink, which fits a patient who quit yesterday.

Hypoglycemia can cause seizures, but there’s no indication of diabetes or low glucose in this scenario, and the strong temporal link to stopping alcohol makes withdrawal the most plausible. Alcohol intoxication would occur while drinking, not after cessation. Diabetic ketoacidosis involves dehydration, polyuria, polydipsia, and acidosis, which aren’t suggested here.