Background: There are approximately 500,000 episodes of alcohol withdrawal that require pharmacologic treatment yearly. Lorazepam is commonly used due to its high therapeutic to-toxic effect index and its status as historically being the usual treatment. Phenobarbital is another common drug used to treat alcohol withdrawal. Patients with heavy alcohol use may become resistant to some [...]

Background: Patients with alcohol use disorder are at high risk of alcohol withdrawal syndrome (AWS) while hospitalized. AWS includes a wide spectrum of clinical features and is associated with significant morbidity and mortality. Pharmacologic treatment of AWS revolves around the use of benzodiazepines (BZDs) or phenobarbital (PHB). Current literature recommends symptom-triggered BZD dosing as first [...]

Background: UNC’s hospitalist service admits on average 9 patients per week with alcohol use disorder (AUD). UNC does not have a standardized inpatient screening tool for assessing risk of Alcohol Withdrawal Syndrome (AWS) nor standardized treatment protocol for AWS. In the 6 months prior to our study, 30% of inpatients at UNC with AUD in [...]

Background: Since the 1960s, benzodiazepine therapy has been the standard of care for alcohol withdrawal syndrome (AWS) [1]. Recently, phenobarbital-based withdrawal has re-emerged as a potentially safer and more effective option that can decrease admission rates when given in the emergency department (ED) [2-7]. Thus, many academic medical centers (AMCs) have switched to phenobarbital for [...]

Case Presentation: The following case describes the excessive use of calcium carbonate (Tums) as a cause of recurrent episodes of pancreatitis. A 39-year-old female presented to the emergency department with severe epigastric pain radiating to her back. The pain was exacerbated by oral intake and was associated with nausea, vomiting, and constipation. Her past medical [...]

Case Presentation: The patient is a 66-year-old female with a pertinent past medical history of Deep Vein Thrombosis on Eliquis, Hyperlipidemia, Osteopenia, Generalized Anxiety Disorder, Major Depressive Disorder, and Hypertension who presented with a chief complaint of persistent generalized abdominal pain, nausea, vomiting, and watery diarrhea. This was the patient’s fourth admission to the hospital [...]

Case Presentation: A 58-year-old man with a history of Lyme disease was diagnosed with babesiosis two weeks earlier, confirmed by positive Babesia Polymerase Chain Reaction (PCR), and treated with a 10-day course of azithromycin and atovaquone. He returned with fatigue and exertional dyspnea, and labs indicated worsening pancytopenia. Suspecting hemolysis and bone marrow suppression from [...]

Case Presentation: A 69-year-old male with a history of hypertension, chronic pancreatic insufficiency secondary to alcohol use and intraductal papillary mucinous neoplasm. Patient underwent a Whipple procedure which was complicated by recurrent gastro-jejunal anastomotic bleeds that improved after EGD with clipping of stomach ulcer and revision of GJ with conversion to Roux-en-Y, ex-lap and wash-out. [...]

Case Presentation: We report a case of a 73-year-old male with a history of occupational exposure to particulates generated from tungsten carbide grinding for eighteen years. Initially, he presented with complaints of progressive exertional dyspnea, chronic cough, and occasional chest tightness over the past two years. He did not endorse any smoking history, exposure to [...]

Case Presentation: – Patient is a 61-year-old female diagnosed with Ornithine Transcarbamylase Deficiency (OTCD) several years ago with hospitalizations for three seizure episodes since diagnosis. These seizures had been triggered by pregnancy, steroids and once due to non-compliance with OTCD medications, respectively. – She got diagnosed with Type 2 Diabetes Mellitus more recently in October [...]