Background: Addressing the needs of the geriatric population is critical, as “baby boomers” comprise a larger proportion of hospitalized patients. Hospitalists increasingly care for these complex geriatric patients. The “BEERS Criteria” are evidence-based guidelines that encourage medication safety by describing potentially inappropriate and harmful medications (PIMS) among geriatric patients. BEERS guidelines recommend that with a [...]

Background: Although alcohol withdrawal (AW) is common in hospitalized patients, few studies describe contemporary alcohol withdrawal management in hospitalized settings or compare practices to recent guidelines published by the American Society of Addiction Medicine (ASAM). We sought to describe patient characteristics and determine factors associated with complicated withdrawal and treatment duration in hospitalized patients with [...]

Background: Background Fatalities caused by drug-overdose have increased in recent years across the US and are now the leading cause of injury-related death in the United States. Drug related deaths with cointoxicants are being seen more often and the increase in prevalence of opioid overdoses with possible concomitant medication use is a public health concern [...]

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 yo male with insulin-dependent diabetes, chronic kidney disease, and bipolar disorder was referred to hospital due to a rising creatinine level and decreased urine output. Home medications included furosemide, insulin, amlodipine, aspirin, quetiapine, lamotrigine and clonazepam. Patient was diagnosed with acute renal failure with serum BUN/creatinine 125 mg/dL / 6.25 mg/dL [...]

Background: Alcohol withdrawal syndrome is a clinical syndrome with clinical manifestations of anxiety, insomnia, irritability, disorientation, hallucinations, seizures, and autonomic hyperactivity. Delirium tremens is the most severe manifestation of alcohol withdrawal. Although benzodiazepines are currently the first line for treatment of alcohol withdrawal, barbiturates are increasingly used for treatment as an alternative[1–3]. We need strong [...]

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 [...]