Background: Screening and treatment for unhealthy alcohol use (UAU) and alcohol use disorder (AUD) is recommended but underutilized, particularly in inpatient settings. Initiating interventions during hospitalization can reduce UAU and may improve clinical outcomes. Methods: We implemented screening and treatment for UAU at a safety-net hospital in Austin, Texas. Nurses screen admitted patients with the [...]

Background: Patients with substance use disorders (SUD) are frequently cared for by hospitalists and admission presents an opportunity to engage patients in SUD treatment. Currently, patients with SUD are undertreated with medications to treat SUD, despite proven reduction in mortality. Addiction consult services are increasingly seen as an intervention to improve the quality of care [...]

Background: Alcohol poses a significant public health concern, contributing to acute and chronic health complications, including organ damage, neurological impairments, and increased mortality. Excessive alcohol consumption can result in poisoning. This study analyzed trends and disparities in mortality rates due to toxic effects of alcohol among different demographics and geographical regions from 1999 to 2020 [...]

Background: Guidelines recommend symptom triggered therapy for management of alcohol withdrawal. The most commonly use assessment scale is the Clinical Institute Withdrawal Assessment, Revised (CIWA-Ar). CIWA-Ar has been criticized however for relying on patient self-report, and alternative scales have been developed that incorporate vital signs to be more objective, including the Minnesota Detoxification Scale (MINDS) [...]

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: A 14-year-old female, with a past medical history of marijuana use and superior mesenteric artery syndrome, presented with tremors, auditory, and visual hallucinations of 1 day duration. Her vital signs were notable for tachycardia ~120 bpm and hypertension (141/89). Her exam was significant for generalized tremors, linear scars from prior self-harm, and tongue [...]

Case Presentation: The patient was an 85-year-old female who presented to the hospital with encephalopathy, rigors, new onset atrial fibrillation with rapid ventricular response and shock. Her past medical history was only noted as dementia and hypertension. Due to her change in mental status, CT head and CTA head and neck were obtained which did [...]

Case Presentation: A 39-year-old male with a history of seizure disorder, depression, and alcohol use disorder presented to the emergency room with new-onset jaundice and a two-week history of fatigue, decreased appetite, and dark orange urine. Social history notable for intermittent and progressive alcohol use starting at the age of 18, with most recent liquor [...]