Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Affecting approximately 5.9% of the US population, alcohol use disorder (AUD) has been established as a prevalent disease in this country (1). Through repeated hospital admissions for alcohol use disorder (including alcohol withdrawal syndromes), hospital costs have steadily risen to recent estimates of 7.6 billion dollars in 2017 (2). Without the establishment of outpatient [...]

Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Affecting approximately 5.9% of the US population, alcohol use disorder (AUD) has been established as a prevalent disease in this country (1). Through repeated hospital admissions for alcohol use disorder (including alcohol withdrawal syndromes), hospital costs have steadily risen to recent estimates of 7.6 billion dollars in 2017 (2). Without the establishment of outpatient [...]

Background: Alcohol withdrawal is a common disorder faced by hospitalists. The pharmacologic standard of care involves the use of benzodiazepines, administered either as fixed doses or with doses adjusted per patient symptoms. At our institution, the alcohol withdrawal protocol previously in place used an institution-specific scale to evaluate patient symptoms, and nurses had latitude within [...]

Background: Alcohol use disorder (AUD) is the most prevalent substance use disorder, but most patients with AUD do not receive evidence-based medications for AUD (MAUD), including naltrexone or acamprosate. Inpatient addiction consult services (ACS) may offer an opportunity to start medical treatment for hospitalized patients with AUD, but it is unknown if ACS are associated [...]

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: 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: Non-Alcoholic Fatty Liver Disease (NAFLD) is defined as the presence of ≥5% of hepatic steatosis (HS) in the absence of other liver disorders, such as chronic viral or autoimmune hepatitis, steatosis induced by drugs, significant alcohol consumption, hemochromatosis, or Wilson’s disease. There is limited literature describing national prevalence and epidemiological characteristics of NAFLD in [...]

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 [...]