Background: Alcohol withdrawal is a common issue in hospitalized patients and is associated with significant morbidity and mortality. Alcohol withdrawal occurs when the gamma aminobutyric acid (GABA) stimulating effect of alcohol is removed, resulting in an excess of the excitatory neurotransmitter glutamate. Treatment typically consists of as needed benzodiazepines, which activate GABA. However, this reactive […]

Background: Although alcohol withdrawal (AW) is common in hospitalized patients, few studies describe contemporary alcohol withdrawal management in hospitalized settings or compare practices to recent guidelines published by the American Society of Addiction Medicine (ASAM). We sought to describe patient characteristics and determine factors associated with complicated withdrawal and treatment duration in hospitalized patients with […]

Background: Phenobarbital (PB) has important pharmacological advantages over benzodiazepines (BZDs) for treatment of alcohol withdrawal syndrome (AWS). The American Society of Addiction Medicine recommends PB monotherapy as an alternative to BZDs for prophylaxis or treatment of AWS by providers experienced with its use. Few studies have described the use of PB for AWS outside of […]

Background: The incidence of Opioid Use Disorder (OUD) is rising around the world with nearly 27 million people living with OUD globally and over 100,000 opioid overdose deaths each year. The Society of Hospital Medicine recently released a consensus statement for management of patients with OUD admitted to the hospital. This statement included recommendations for […]

Background: Approximately 5% of patients hospitalized at our institution develop clinically significant alcohol withdrawal syndrome (AWS). Inpatients who develop AWS may experience seizures, delirium, ICU transfer and prolonged length of stay. While the mortality of AWS, mostly related to delirium tremens, has decreased over time, severe alcohol withdrawal is still associated with a mortality of […]

Case Presentation: A 43-year-old woman with general anxiety disorder and benzodiazepine abuse was brought to the emergency department by her husband with nausea, diarrhea, agitation, and altered mental status. She also endorsed restlessness and muscle tension. Examination revealed an agitated, disoriented woman with three days of amnesia. Vitals signs were within normal limits. Drug and […]