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: 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 54-year-old tracheostomy and gastric tube dependent, non-verbal male with chronic spastic quadriplegia, autonomic dysautonomia, and recent ICU admissions for MDR pneumonia presented to the emergency department from his skilled nursing facility with acute hypertension. His home medications were notable for hydralazine, isosorbide mononitrate, clonidine, midodrine, and an intrathecal baclofen pump. He was [...]

Case Presentation: A 42 year-old man with a past medical history of alcohol use disorder, depression and prior suicide attempt who was admitted to psychiatry after a gabapentin overdose while intoxicated. His home medications included sertraline, naltrexone, and gabapentin. Ethanol level on admission was 204 mg/dL. Sertraline was continued and he was started on trazodone [...]

Case Presentation: A 61-year-old man with a history of opioid use disorder, methamphetamine use disorder, and chronic bilateral lower extremity wounds presented with worsening lower extremity pain and drainage (Figures 1 and 2). He was admitted for intravenous antibiotic treatment for lower extremity cellulitis. He reported inhaling fentanyl and methamphetamine on the day of presentation, [...]

Case Presentation: A 34-year-old female with a history of alcohol use disorder presented with severe withdrawal symptoms approximately one hour after receiving her first dose of naltrexone, which was prescribed for the management of alcohol cravings. The symptoms included excessive yawning, anxiety, irritability, tachycardia, generalized muscle cramps, and discomfort. Laboratory investigations revealed a blood alcohol [...]