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 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: Vent withdrawal (VW) is a procedure offered when an intubated patient fails to demonstrate meaningful recovery, the patient is not likely to survive given the extent or burden of underlying medical conditions, or patient’s best anticipated outcome from ongoing ventilator support is inconsistent with patient’s known or presumed wishes. Comfort of the patient after [...]

Background: Acute alcohol withdrawal syndrome (AWS) is a common complication in hospitalized patients, but its occurrence and severity is difficult to predict based on clinical indicators alone. Phosphatidylethanol (PEth) is an abnormal phospholipid incorporated into erythrocyte lipid bilayers in proportion to levels of alcohol exposure, with a half-life of 5 to 10 days. We sought [...]

Background: Treating alcohol withdrawal in the inpatient medical setting requires timely identification of the severity of alcohol withdrawal so appropriate treatment can be administered. Delayed or missed diagnosis can lead to increased morbidity and mortality, increased cost and length of stay, and ICU admissions. CIWA-Ar is the most commonly used scale, but it is lengthy [...]

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 [...]