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: Alcohol use disorder (AUD) Is present in 10% of adults and its prevalence is increasing. When patients with AUD are admitted to the hospital, half develop alcohol withdrawal syndrome (AWS), which can cause delirium, hallucinations, seizures, and even mortality if not treated appropriately. A fixed-dose phenobarbital strategy may be superior to the standard of [...]

Background: Heart failure (HF) and atrial fibrillation (AF) share several risk factors including coronary artery disease, hypertension, smoking, obesity, diabetes, and renal disease, as well as common pathophysiologic pathway involving activation of the renin–angiotensin–aldosterone system, maladaptive atrial remodeling and subsequent impaired conduction system. Some studies have supported the role of angiotensin converting enzyme inhibitors (ACEIs) [...]

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 [...]

Case Presentation: A 40-year-old previously healthy female presented nine weeks postpartum with numerous episodes of nonbilious, nonbloody emesis that began 24 hours prior to admission. She took no medications and denied fevers, chills, dysuria, cough, or ingestion of alcohol or other substances. She reported that since her uncomplicated vaginal birth, she had been adhering to [...]

Case Presentation: A 65-year-old man with a history of nasal polyps was admitted to the hospital with a lactate of 10 mmol/L (0.5-2.2 mmol/L). He reported drenching night sweats and a 10-pound weight loss over the last 2-3 months. He noted orthostatic and ambulatory dizziness, as well as left-sided tinnitus, sinus pain, and nosebleeds over [...]

Case Presentation: A 90 year old female, with diabetes mellitus type 2, hypertension and osteoporosis presented to our emergency room with altered mental status for 5 days. The patient had been treated for jaw osteonecrosis over the past 6 months which included multiple debridements and IV antibiotics. She was started on IV ertapenem 1g daily [...]

Case Presentation: A 91-year-old male with a known history of benign prostatic hyperplasia (BPH), diastolic heart failure, pulmonary embolism, hypertension, and previous extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) urinary tract infection (UTI) presented with encephalopathy. He was not tachypneic nor tachycardic, but his bicarbonate was low at less than 8, and his lactic acid [...]

Case Presentation: A 68 year old male with history of hemodialysis dependent chronic kidney disease, stroke and vascular dementia was transferred from a nursing home with increased lethargy and abdominal pain.  In the emergency department he was found to be febrile to 101.9°F and abdominal exam revealed involuntary guarding with diffuse pain to deep palpation.  [...]

Case Presentation: A 74-year-old female, with no significant past medical or travel history, developed sepsis 2 days after undergoing debulking surgery for stage IIIc ovarian carcinoma. Blood cultures were positive for gram-negative bacilli and the organisms identified as Enterobacter spp. with blaIMP MBL (Verigene). Antimicrobial susceptibility testing demonstrated high-level resistance to all penicillins, ureidopenicillins, cephalosporins, [...]