Background: It is estimated that 20% of patients who encounter the ED suffer from Alcohol Use Disorder (AUD) . Hospitalists encounter many Alcohol Withdrawal admissions and are often tasked with providing short counseling sessions on AUD due to time restraints. Furthermore, up to 50% of of patents admitted for Alcohol withdrawal will be readmitted for [...]

Background: Alcoholic hepatitis (AH) related admissions have been increasing, and severe AH (as defined by a discriminant function [DF] > 32) can carry a one-month mortality rate of up to 50% (Crabb et al). With rising mortality from alcoholic liver disease, early detection of alcohol use disorder to achieve cessation and prevent progression to alcoholic [...]

Background: Up to 12% of hospitalized patients require high dose parenteral thiamine treatment to prevent Wernicke’s Encephalopathy, a devastating and easily preventable neurologic disorder that can lead to death. Despite the fact that it is as simple and relatively inexpensive therapy with no known side effects, high dose thiamine continues to be underutilized. Attempts to [...]

Background: Severe alcohol withdrawal and delirium tremens (DTs) are challenging therapeutic dilemmas. To prevent complications and death, management requires close monitoring and intensive treatment, frequently in an ICU. Benzodiazepines are first line therapeutic agents, but optimal use and dosing has been limited, due to a lack of randomized double-blind trials. In lower acuity patients admitted [...]

Background: New Mexico has the highest number of alcohol-related deaths in the country, a title held since 1981. Nationally 1 in 10 deaths in working-aged adults are alcohol-associated whereas in New Mexico the ratio is 1 in 6 deaths. About 130,000 New Mexicans report alcohol dependence or abuse within the past year, but only 3% [...]

Background: Prevalence of alcohol use disorder (AUD) on inpatient medicine wards exceeds 40%. Only 50% of these patients develop alcohol withdrawal, of whom only 5-20% develop complicated alcohol withdrawal syndromes (AWS) that warrant treatment and monitoring. Overutilization of the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) scale is well-reported in the literature. CIWA-Ar [...]

Case Presentation: A 65 year old male with no significant medical history presented to an outside facility complaining of fatigue, weakness, nausea and vomiting. He had moderate alcohol history and significant weight loss over the past 6 months. Initial lab workup was notable for elevated liver transaminases with a hepatocellular pattern, Maddrey score of 53.6 [...]

Case Presentation: A 46 year old African American woman presented with one week of worsening hearing loss along with 3 days of vision changes, confusion, visual hallucinations, and difficulty ambulating. She had history of invasive ductal cell carcinoma status-post mastectomy and chemotherapy. Additional history included hemorrhoids for which she underwent hemorrhoidectomy due to excessive bleeding [...]

Case Presentation: A 29 year old female presents with one week of sudden onset double vision. She reports accompanying dark spots in her vision, photosensitivity, and some unsteadiness with walking. The patient’s friend noted that her eyes were “crossed” the morning of admission. Past medical history is significant for alcohol abuse and anxiety with a [...]

Case Presentation: A 69-year-old woman presented for an elective multi-level lumbar laminotomy for the treatment of chronic back pain secondary to spinal canal stenosis. Her medical history included hypertension and hypercholesterolemia. She reported a history of depression, which was well controlled on paroxetine. She denied using drugs, stated she quit tobacco decades prior, and reported [...]