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    A Rare Case of Complicated Opioid Withdrawal in Delirium Without Convulsions.
    Indian J Psychol Med 2017 Mar-Apr;39(2):191-193
    Department of Psychiatry, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.
    Opioids are one of the commonly abused substances in India. Opioid withdrawal symptoms classically include severe muscle cramps, bone aches, autonomic symptoms, anxiety, restlessness, insomnia, and temperature dysregulation. However, reports of cases with delirium during withdrawal are few. Read More

    Impact of an Alcohol Withdrawal Treatment Pathway on Hospital Length of Stay: A Retrospective Observational Study Comparing Pre and Post Pathway Implementation.
    J Psychiatr Pract 2017 May;23(3):233-241
    MUZYK: Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC; Department of Pharmacy, Duke University Hospital, Durham, NC; and Department of Psychiatry and Behavioral Sciences, Duke University Health System, Durham, NC ROGERS: Department of Pharmacy, Duke University Hospital, Durham, NC DIGHE: Department of Pharmacy, Ohio State University-Ohio Riverside Hospital, Columbus, OH HARTUNG: Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC MUSSER: Department of Medicine, Duke University Health System, Durham, NC STILLWAGON: Department of Nursing, Duke University Health System, Durham, NC RIVELLI: Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University Health System, Durham, NC.
    Objective: To determine if the implementation of a hospital-specific alcohol withdrawal treatment pathway used in a medical-surgical patient population decreased hospital length of stay (LOS) compared with the standard of care.

    Methods: This retrospective observational study, conducted in a large academic tertiary care hospital, involved 582 subjects who met criteria for study inclusion, with 275 subjects in the 2010 cohort and 307 in the 2012 cohort. The Alcohol Withdrawal Project Team was formed with the goal of creating a standardized approach to the recognition and treatment of alcohol withdrawal at Duke University Hospital. Read More

    Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal.
    Case Rep Med 2017 10;2017:3894749. Epub 2017 Apr 10.
    Department of Psychiatry, Faculty of Medicine, Sakarya University, 54100 Sakarya, Turkey.
    Synthetic cannabinoids (SCs) are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2-100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Read More

    Comparison of Clinical Outcomes Following Head and Neck Surgery Among Patients Who Contract to Abstain From Alcohol vs Patients Who Abuse Alcohol.
    JAMA Otolaryngol Head Neck Surg 2017 Apr 26. Epub 2017 Apr 26.
    The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus2Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus.
    Importance: Alcohol abuse is highly prevalent in the population of patients with head and neck cancer, and active abuse at the time of surgery results in poor postoperative outcomes.

    Objective: To determine the association of alcohol abstinence with postoperative outcome in alcohol misusers undergoing major surgical procedures of the head and neck.

    Design, Setting, And Participants: As a case-control study, from July 2013 to August 2015, outcomes were collected in patients at an academic tertiary referral center requiring free flap reconstruction who had undergone an abstinence contract (n = 15) and compared with those who were abusers of alcohol prior to the inception of the protocol (n = 30). Read More

    [Alcohol withdrawal and its major complications].
    Fortschr Neurol Psychiatr 2017 Mar 20;85(3):163-177. Epub 2017 Mar 20.
    Delirium tremens is one of the most common complications of alcohol withdrawal. It is potentially lethal and therefore should be detected as early as possible and be monitored and treated intensively. The assessment of risk factors with the Luebeck Alcohol-Withdrawal Risk Scale short form (LARS-11) can help to predict the risk of severe withdrawal adequately. Read More

    Occurrence, Predictors, and Prognosis of Alcohol Withdrawal Syndrome and Delirium Tremens Following Traumatic Injury.
    Crit Care Med 2017 May;45(5):867-874
    1Trauma Research Department, Swedish Medical Center, Englewood, CO. 2Trauma Research Department, St. Anthony Hospital, Lakewood, CO. 3Trauma Research Department, Medical Center of Plano, Plano, TX. 4Trauma Research Department, Penrose Hospital, Colorado Springs, CO. 5Molecular Biology Department, Rocky Vista University, Parker, CO.
    Objectives: We sought to determine occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens in patients with traumatic injury.

    Design: Retrospective multicenter cohort study.

    Setting: Three U. Read More

    The emergency medicine management of severe alcohol withdrawal.
    Am J Emerg Med 2017 Feb 4. Epub 2017 Feb 4.
    The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States. Electronic address:
    Introduction: Alcohol use is widespread, and withdrawal symptoms are common after decreased alcohol intake. Severe alcohol withdrawal may manifest with delirium tremens, and new therapies may assist in management of this life-threatening condition.

    Objective: To provide an evidence-based review of the emergency medicine management of alcohol withdrawal and delirium tremens. Read More

    [Combination of DAT and DBH gene polymorphisms with a family history of alcohol use disorders increases the risk of withdrawal seizures and delirium tremens during alcohol withdrawal in alcohol-dependent men].
    Zh Nevrol Psikhiatr Im S S Korsakova 2016;116(12):68-80
    Shchelkovo Region Dispensary of Narcology, Shchelkovo, Moscow Region, Russia.
    Aim: To explore the genetic influence of a family history of alcohol use disorders and the dopamine transporter SLC6A3 (DAT1) and dopamine beta-hydroxylase (DBH) gene polymorphisms on the risk of severe complications (withdrawal seizures (AWS) and delirium tremens (DT)) during alcohol withdrawal in alcohol-dependent men.

    Material And Methods: We investigated the effects of 3 previously reported candidate genetic variations: 40-bp variable number tandem repeat (VNTR) polymorphism and C/T exon 15 (rs27072) in the 3' untranslated region (3' UTR) of the SLC6A3(DAT1) gene, and -1021 C/T (rs1611115) of DBH gene in 266 alcohol-dependent Russian male inpatients in two groups by presence (SC group: AWS, DT, AWS+DT, n=130) or absence (n=136) of severe complications diagnosed by ICD-10 during current alcohol withdrawal. Clinically important information and a family history of alcohol use disorders (FH) were obtained by semi-structured interview. Read More

    Diazepam in the Treatment of Moderate to Severe Alcohol Withdrawal.
    CNS Drugs 2017 Feb;31(2):87-95
    Division of Hospital Medicine, Department of Medicine, Saint Louis Veterans Affairs Medical Center, John Cochran Division, 915 North Grand Avenue, Saint Louis, 63106, MO, USA.
    Benzodiazepines ameliorate or prevent the symptoms and complications of moderate to severe alcohol withdrawal, which can include autonomic hyperactivity, agitation, combativeness, hallucinations, seizures, delirium, and death. The benzodiazepines most commonly used for this purpose are lorazepam, chlordiazepoxide, oxazepam, and diazepam. It is widely asserted that no member of this group is superior to the others for treatment of alcohol withdrawal. Read More

    A systematic nurse-led approach to withdrawal risk screening, prevention and treatment among inpatients with an alcohol use disorder in an ear, nose, throat and jaw surgery department-A formative evaluation.
    Appl Nurs Res 2017 Feb 25;33:155-163. Epub 2016 Nov 25.
    Department of Nursing and Allied Health Professions, Practice Development Unit Nursing, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland; University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland. Electronic address:
    Introduction: Among patients with head and neck cancer comorbid alcohol use disorder is frequent which contributes to higher risk of developing perioperative alcohol withdrawal syndrome/delirium or delirium due to medical conditions. Although guidelines emphasize prevention and treatment of alcohol withdrawal in hospitalized patients, a validated systematic approach for management of these patients is still lacking. Our aim was to formatively evaluate our newly developed systematic approach in view of nurses' adherence to screening patients for regular alcohol consumption and managing their withdrawal symptoms using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised. Read More

    Embracing a Nurse-Driven Alcohol Withdrawal Protocol Through Quality Improvement.
    J Addict Nurs 2016 Oct/Dec;27(4):234-240
    John Barrett, MA, BSN, RN, Duke University School of Nursing, Durham, NC. Maria Jansen, PharmD, Matthew Felbinger, PharmD, BCPS, and Faith Waters, MSN, RN, NEA-BC, Duke Regional Hospital, Durham, NC. April Cooper, PharmD, Duke Regional Hospital, Durham, and College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC.
    Background: Alcohol withdrawal can lead to severe complications including seizures, delirium tremens, and death if not treated appropriately. Nurses are critical to the safety and outcomes of these patients.

    Objective: The objective of this retrospective study was to determine if nursing education on a community hospital's alcohol withdrawal protocol led to improved nursing compliance. Read More

    Deaths in Unlicensed Alcohol Rehabilitation Facilities.
    J Forensic Sci 2017 01 16;62(1):103-106. Epub 2016 Nov 16.
    Department of Medical Examiner-Coroner, 1104 North Mission Road, Los Angeles, CA, 90033.
    Non-English-speaking people do not always seek medical care through established institutions. This paper reports a series of deaths in unlicensed alcohol rehabilitation facilities serving Spanish-speaking men. These facilities are informal groups of alcohol abusing men who live together. Read More

    Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.
    J Laryngol Otol 2016 May;130(S2):S13-S22
    Department of Anaesthesia,Freeman Hospital,Newcastle upon Tyne NHS Foundation Trust,Newcastle upon Tyne,UK.
    This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer. Recommendations • Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. Read More

    Outcomes After Implementation of an Alcohol Withdrawal Protocol at a Single Institution.
    Hosp Pharm 2016 Oct;51(9):752-758
    Background: There are varying dosing strategies for the administration of benzodiazepines in the setting of alcohol withdrawal. In October 2014, a symptom-based alcohol withdrawal protocol (AWP) using the Clinical Institute Withdrawal Assessment of Alcohol, Revised (CIWA-Ar) scale was implemented at one institution. Objective: To evaluate the safety and efficacy of the AWP. Read More

    Self-disembowelment during delirium tremens: why early diagnosis is vital.
    BMJ Case Rep 2016 Oct 24;2016. Epub 2016 Oct 24.
    University of Manchester, Manchester, UK.
    Delirium tremens is a serious yet treatable complication of alcohol withdrawal. Timely diagnosis is critical as there are well-established treatment regimens that provide symptomatic relief within hours to days. We report the case of a 34-year-old man with an undisclosed history of alcohol dependency. Read More

    Clinical Evolution of Central Pontine Myelinolysis in a Patient with Alcohol Withdrawal: A Blurred Clinical Horizon.
    Case Rep Med 2016 16;2016:6065259. Epub 2016 Aug 16.
    Deccan College of Medical Sciences, Kanchanbagh, Hyderabad, Telangana 500058, India.
    Central pontine myelinolysis (CPM), a potentially fatal and debilitating neurological condition, was first described in 1959 in a study on alcoholic and malnourished patients. It is a condition most frequently related to rapid correction of hyponatremia. Chronic alcoholism associated CPM tends to be benign with a favorable prognosis compared to CPM secondary to rapid correction of hyponatremia. Read More

    Alcohol withdrawal syndrome: mechanisms, manifestations, and management.
    Acta Neurol Scand 2017 Jan 1;135(1):4-16. Epub 2016 Sep 1.
    Department of Neurology, University Ulm, Ulm, Germany.
    The alcohol withdrawal syndrome is a well-known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Nonetheless, diagnosis and treatment are often delayed until dramatic symptoms occur. Read More

    Baclofen to prevent agitation in alcohol-addicted patients in the ICU: study protocol for a randomised controlled trial.
    Trials 2016 Aug 19;17(1):415. Epub 2016 Aug 19.
    Departments of Anaesthesiology and Surgical Intensive Care, Hôtel-Dieu, University Hospital of Nantes, 44093, Nantes, France.
    Background: Alcohol is the leading psychoactive substance consumed in France, with about 15 million regular consumers. The National institute on Alcohol Abuse and Alcoholism (NIAAA) considers alcohol abuse to be more than 14 units of alcohol a week for men and 7 units for women. The specific complication of alcoholism is the alcohol withdrawal syndrome. Read More

    [Aggression and restlessness following baclofen overdose: the narrow line between intoxication and withdrawal symptoms].
    Ned Tijdschr Geneeskd 2016 ;160:A9604
    Universitair Medisch Centrum Utrecht, Utrecht.
    Background: Baclofen is increasingly prescribed for alcohol dependency. Subsequently, the risk of self-intoxication with this medicinal product is increasing.

    Case Description: A 23-year-old man with a history of alcohol dependence was admitted to our hospital after self-intoxication with 2700 mg baclofen and 330 mg mirtazapine. Read More

    [Ambulant treatment of alcohol withdrawal].
    Dtsch Med Wochenschr 2016 Jul 27;141(15):1113-4. Epub 2016 Jul 27.
    Most of the patients addicted to alcohol are socially well integrated. The offer of a low threshold ambulant withdrawal therapy opens an opportunity to build a sustainable therapeutic relationship. The so started empathic addiction therapy will be well accepted and will lead to a satisfying outcome. Read More

    [Dexmedetomidine in the treatment of acute alcohol withdrawal delirium].
    Anaesthesist 2016 Jul;65(7):525-31
    Klinik für Anästhesiologie und Intensivmedizin, Klinikum Neumarkt, Neumarkt i. d. OPf., Nürnberger Straße 12, 92318, Neumarkt, Deutschland.
    Alcohol withdrawal syndrome has a high clinical prevalence. Severe cases must be treated in an intensive care unit and are associated with a high mortality rate, depending on patient comorbidities. Clinical requirements include sedation, control of vegetative symptoms, treatment of hallucinations and, when necessary, anticonvulsive therapy. Read More

    Meta-Analysis Reveals Significant Association of the 3'-UTR VNTR in SLC6A3 with Alcohol Dependence.
    Alcohol Clin Exp Res 2016 Jul 24;40(7):1443-53. Epub 2016 May 24.
    State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China.
    Background: Although many studies have analyzed the association of 3'-untranslated region variable-number tandem repeat (VNTR) polymorphism in SLC6A3 with alcohol dependence (AD), the results remain controversial. This study aimed to determine whether this variant indeed has any genetic effect on AD by integrating 17 reported studies with 5,929 participants included.

    Methods: The A9-dominant genetic model that considers A9-repeat and non-A9 repeat as 2 genotypes and compared their frequencies in alcoholics with that in controls was adopted. Read More

    Central pontine myelinolysis in a case of alcohol dependence syndrome.
    Ind Psychiatry J 2015 Jul-Dec;24(2):198-201
    Department of Psychiatry, INHS Asvini, Mumbai, Maharashtra, India.
    Osmotic Demyelination Syndrome includes Central Pontine Myelinolysis and Extrapontine Myelinolysis. This condition has been described in cases of chronic Alcohol Dependence Syndrome and in rapid correction of hyponatremia. Though we frequently see patients with Alcohol Dependence Syndrome presenting with complicated withdrawal, Central Pontine Myelinolysis remains largely undetected and under-reported in literature. Read More

    The Role of Barbiturates for Alcohol Withdrawal Syndrome.
    Psychosomatics 2016 Jul-Aug;57(4):341-7. Epub 2016 Mar 2.
    Department of Education, Lehigh Valley Health Network, Allentown, PA (AK).
    Background: Benzodiazepine-resistant cases of alcohol withdrawal syndrome are common, and therefore alternate treatments are needed.

    Objective: Our aim was to conduct a systematic review of published reports on the use of barbiturates for alcohol withdrawal syndrome.

    Methods: We performed a systematic literature search of PUBMED for relevant citations that described the use of barbiturates either alone or in conjunction with other pharmacological agents to treat alcohol withdrawal syndrome. Read More

    [Postictal psychoses: Clinical and neurobiological findings].
    Encephale 2016 Oct 16;42(5):443-447. Epub 2016 May 16.
    Clinique neuropsychiatrique, université médicale d'Aichi, 1-1, Yazako Karimata, Nagakute, Aichi, Japon. Electronic address:
    Psychosis in epilepsy can be categorized in relation to seizures in two main categories: interictal psychosis and postictal psychosis. Postictal psychosis (PIP) is a specific syndrome in relation to seizure activity: a clear temporal relation exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures. However, this very specific syndrome is not included as such within the DSM-5, and PIP belongs to the category "Psychotic disorder due to another medical condition". Read More

    Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients.
    Pharmacotherapy 2016 Jul 30;36(7):797-822. Epub 2016 Jun 30.
    Harrison School of Pharmacy, Auburn University, Auburn, Alabama.
    Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice. Read More

    [Delirium: Concepts, Etiology, and Clinical Management].
    Fortschr Neurol Psychiatr 2016 Apr 21;84(4):233-44. Epub 2016 Apr 21.
    Delirium is a common condition: up to 35 percent of non-ICU- and 80 percent of ICU-patients experience delirium - particularly the elderly suffering from cerebral dysfunction accompanied by acute infection, surgery, or change of medication. Medical staff should be alert for decrease (within hours) of concentration, memory, orientation, and consciousness - especially when agitation appears and symptoms are fluctuating. Vegetative lapses and seizures may complicate the course, in particular in delirium in withdrawal (of alcohol or drugs). Read More

    Assessment of Pharmacological Treatment Quality: Comparison of Symptom-triggered vs. Fixed-schedule Alcohol Withdrawal in Clinical Practice.
    Pharmacopsychiatry 2016 Sep 21;49(5):199-203. Epub 2016 Apr 21.
    Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany.
    Introduction: Despite the fact, that symptom-triggered alcohol withdrawal treatment is recommended by German guidelines on alcoholism, many hospitals continue to use fixed-schedule protocols, as they have been successfully applied for many years. Methods: This retrospective study compared all patients' records of alcohol withdrawal treatment from October 2010 to November 2011 at Magdeburg's University Department of Psychiatry (n=120). A symptom-triggered protocol with clomethiazole (AESB, n=46) was used in parallel with the existing fixed-schedule protocol with diazepam (n=74). Read More

    [Comparison of Two Symptom-Triggered Treatments for Alcohol Withdrawal: HAES vs. SAB-P].
    Fortschr Neurol Psychiatr 2016 Feb 8;84(2):83-7. Epub 2016 Mar 8.
    Klinik für Psychiatrie und Psychotherapie, UKE Hamburg.
    Introduction: For alcohol withdrawal during hospitalization, often a medication as means for withdrawal needs to be chosen. Modern, score-controlled processes that can be used by the nursing staff after instruction by physicians are frequently not used and even unknown in hospitals. One reason for this is that some of the scores require checking several criteria and are therefore more time-consuming and complicated than use of a fixed-dosage strategy. Read More

    Alcohol and Sedative-Hypnotic Withdrawal Catatonia: Two Case Reports, Systematic Literature Review, and Suggestion of a Potential Relationship With Alcohol Withdrawal Delirium.
    Psychosomatics 2016 May-Jun;57(3):246-55. Epub 2015 Dec 22.
    Department of Psychiatry, Yale School of Medicine, New Haven, CT.
    Background: Withdrawal from alcohol and sedative-hypnotics can be complicated by seizures, hallucinations, or delirium. Withdrawal catatonia is another, less commonly discussed complication that clinicians should appreciate.

    Methods: We present a case of alcohol withdrawal catatonia and a case of benzodiazepine withdrawal catatonia and offer a systematic review of previous cases of alcohol or sedative-hypnotic withdrawal catatonia. Read More

    Symptom profile of alcohol withdrawal delirium: factor analysis of Delirium Rating Scale-Revised-98 version.
    Am J Drug Alcohol Abuse 2016 Mar 23;42(2):196-202. Epub 2016 Feb 23.
    a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India.
    Background: The symptom profile of alcohol withdrawal delirium (AWD), relative to deliriums of other etiology, remains uncertain.

    Objective: To evaluate the factor structure of symptoms in patients with AWD, as assessed by the Delirium Rating Scale-Revised-98 (DRS-R-98).

    Method: A total of 112 patients aged 18 years or more with AWD were assessed on DRS-R-98. Read More

    Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature.
    Pharmacotherapy 2016 Apr 1;36(4):433-42. Epub 2016 Apr 1.
    University of Arkansas for Medical Sciences Medical Center, Little Rock, Arkansas.
    The authors evaluated all available evidence on the use of propofol as an adjuvant for the treatment of resistant alcohol withdrawal syndrome (AWS) in comparison to other therapies. A comprehensive PubMed search (1966-December 2015) was conducted using the search terms propofol, alcohol withdrawal, and drug therapy. Articles were cross-referenced for other citations. Read More

    Treatment of Severe Alcohol Withdrawal.
    Ann Pharmacother 2016 May 9;50(5):389-401. Epub 2016 Feb 9.
    Beaumont Hospital, Royal Oak, MI, USA.
    Objective: Approximately 50% of patients with alcohol dependence experience alcohol withdrawal. Severe alcohol withdrawal is characterized by seizures and/or delirium tremens, often refractory to standard doses of benzodiazepines, and requires aggressive treatment. This review aims to summarize the literature pertaining to the pharmacotherapy of severe alcohol withdrawal. Read More

    Alcoholism and critical illness: A review.
    World J Crit Care Med 2016 Feb 4;5(1):27-35. Epub 2016 Feb 4.
    Ashish Jitendra Mehta, Division of Pulmonary Critical Care Medicine, Department of Medicine, Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, GA 30322, United States.
    Alcohol is the most commonly used and abused drug in the world, and alcohol use disorders pose a tremendous burden to healthcare systems around the world. The lifetime prevalence of alcohol abuse in the United States is estimated to be around 18%, and the economic consequences of these disorders are staggering. Studies on hospitalized patients demonstrate that about one in four patients admitted to critical care units will have alcohol-related issues, and unhealthy alcohol consumption is responsible for numerous clinical problems encountered in intensive care unit (ICU) settings. Read More

    Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management.
    Crit Care Nurse 2016 Feb;36(1):28-38
    Lynsey Sutton is an associate charge nurse manager of a level 3 intensive care unit, Capital and Coast District Health Board, Wellington Regional Hospital, Riddiford, Wellington, New Zealand. She is a guest teaching assistant in the postgraduate nursing program at Victoria University of Wellington, New Zealand.Annemarie Jutel works at Victoria University of Wellington. She is also a locum emergency nurse in Central Otago, New Zealand.
    Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Read More

    Outcomes of Patients with Alcohol Withdrawal Syndrome Treated with High-Dose Sedatives and Deferred Intubation.
    Ann Am Thorac Soc 2016 Feb;13(2):248-52
    2 Hospital of Central Connecticut, New Britain, Connecticut.
    Rationale: High doses of sedating drugs are often used to manage critically ill patients with alcohol withdrawal syndrome.

    Objectives: To describe outcomes and risks for pneumonia and endotracheal intubation in patients with alcohol withdrawal syndrome treated with high-dose intravenous sedatives and deferred endotracheal intubation.

    Methods: Observational cohort study of consecutive patients treated in the intensive care unit (ICU) of a university-affiliated, community hospital for alcohol withdrawal syndrome, where patients were not routinely intubated to receive high-dose or continuously infused sedating medications. Read More

    Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials.
    J Crit Care 2016 Apr 8;32:101-7. Epub 2015 Dec 8.
    Mercy Medical Center, 271 Carew Street, Springfield, MA 01104. Electronic address:
    Purpose: To perform a systematic review of the clinical trials concerning the use of barbiturates for the treatment of acute alcohol withdrawal syndrome (AWS).

    Materials And Methods: A literature search of MEDLINE, EMBASE, and the Cochrane Library, together with a manual citation review was conducted. We selected English-language clinical trials (controlled and observational studies) evaluating the efficacy and safety of barbiturates compared with benzodiazepine (BZD) therapy for the treatment of AWS in the acute care setting. Read More

    Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies.
    CNS Neurosci Ther 2016 Jan;22(1):25-37
    Société Française d'Alcoologie, Issy-les-Moulineaux, France.
    Background: The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence.

    Methods: A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). Read More

    Alcohol withdrawal management in adult patients in a high acuity medical surgical transitional care unit: a best practice implementation project.
    JBI Database System Rev Implement Rep 2016 Jan 15;13(12):314-34. Epub 2016 Jan 15.
    University of California San Francisco.
    Background: Excessive alcohol consumption, a major health problem worldwide, affects about 6% of the United States population. Caring for patients with alcohol withdrawal syndrome in a hospital ward presents complex physiologic and psycho-social challenges which are best met with evidence-based practices. An academic medical center in the United States has been experiencing an increase in patients with alcohol withdrawal syndrome. Read More

    Alcohol withdrawal syndrome in medical patients.
    Cleve Clin J Med 2016 Jan;83(1):67-79
    Clinical Pharmacist Specialist in Internal Medicine, Harper University Hospital, Detroit, MI, USA.
    The authors provide a critical review focusing on pharmacotherapy of alcohol withdrawal syndrome in hospitalized patients who are not critically ill. They outline recommendations for patient assessment and monitoring. Read More

    Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care.
    BMJ Qual Improv Rep 2015 16;4(1). Epub 2015 Jul 16.
    United Kingdom, Wales.
    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of stay of 5. Read More

    Correlation Between Partial Pressure of Arterial Carbon Dioxide and End Tidal Carbon Dioxide in Patients with Severe Alcohol Withdrawal.
    Ochsner J 2015 ;15(4):418-22
    Department of Pulmonary/Critical Care Medicine, Advocate Christ Medical Center, Oak Lawn, IL.
    Background: Respiratory depression is a common adverse effect of benzodiazepine administration to patients with severe alcoholic withdrawal. This study was conducted to assess the value of end tidal carbon dioxide (ETCO2) levels compared to partial pressure of arterial carbon dioxide (PaCO2) levels in monitoring respiratory depression secondary to benzodiazepine treatment in patients with severe alcohol withdrawal.

    Methods: We retrospectively analyzed 36 patients admitted to the intensive care unit for severe alcohol withdrawal who had been administered sedative agents. Read More

    Anger and its Association with Substance Use Treatment Outcomes in a Sample of Adolescents.
    J Child Adolesc Subst Abuse 2016 4;25(5):391-398. Epub 2016 May 4.
    Yale University School of Medicine, New Haven, CT, USA.
    Anger is a common affective experience, yet it is relatively understudied in the substance use treatment literature. This study explored anger as a predictor of treatment outcomes in a large sample of adolescents. Data were extracted from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A). Read More

    Clinical applications of sodium oxybate (GHB): from narcolepsy to alcohol withdrawal syndrome.
    Eur Rev Med Pharmacol Sci 2015 Dec;19(23):4654-63
    Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy.
    Gamma-hydroxybutyrate (GHB) is a short chain fatty acid endogenously produced within the central nervous system (CNS) and acts as a precursor and metabolite of the inhibitory neurotransmitter γ-aminobutyric acid (GABA). Although, it is an illegal recreational drug of abuse, its sodium salt (sodium oxybate) has been utilized as a medication for a number of medical conditions. The first aim of this review was to focus on current applications of sodium oxybate for the treatment of narcolepsy, with a particular emphasis on the key symptoms of this disorder: cataplexy and excessive daytime sleepiness (EDS). Read More

    Takotsubo cardiomyopathy precipitated by delirium tremens.
    J Community Hosp Intern Med Perspect 2015 11;5(6):29704. Epub 2015 Dec 11.
    Interfaith Medical Center, Brooklyn, NY, USA.
    A 57-year-old woman presented with alcohol withdrawal symptoms, which later progressed to delirium tremens. During hospitalization, she developed respiratory distress with acute pulmonary edema. Electrocardiogram (ECG) showed diffuse ST elevation with elevated cardiac enzymes. Read More

    [APPLICATION OF DEXMEDETOMIDIN FOR SEDATION OF PATIENTS IN ALCOHOL WITHDRAWAL STATE IN THE ICU].
    Klin Khir 2015 Jul(7):62-4
    The efficacy and safety of sedation on 44 patients in alcohol withdrawal state (AWS) for use of intravenous dexmedetomidine infusion. Dexmedetomidine increased the duration of target sedation level to 20%, decreased the duration of excessive/insufficient sedation to 10%, it was associated with AWS symptoms regression, better communication with the patient, reduced consumption of benzodiazepines (BZD) from 40 to 30 mg per day and antypsihotics for control AWS symptoms. The common complications of dexmedetomidine infusion were bradycardia and hypotension. Read More

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